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^BOARD OF EDUCATION. .,^^,,^.^^3,,^^ 

THE CITY oFnEW YORK (city) 



ANNUAL REPORT 

OF THE 

SUPERINTENDENT 
OF SCHOOLS 

1918-1919-1920 



Reports on Special Classes 

MENTAL DEFECTIVES THE CRIPPLED 

OPEN AIR CLASSES INDUSTRIAL AND 

THE BLIND AND SIGHT PLACEMENT WORK 

CONSERVATION THE CARDIAC 

THE DEAF ' SPEECH IMPROVEMENT 

TRUANT AND PROBATIONARY SCHOOLS 
VISITING TEACHERS 



PRESENTED TO THE BOARD OF EDUCATION 
DECEMBER 22, 1920 



TWENTIETH 
TWENTY-FIRST 
TWENTY-SECOND 
ANNUAL REPORTS 



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LIBRARY OF CONGRESS 



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JUN11192t 
poouMEHTs ki. Vision 



TABLE OF CONTENTS 



PAGE 

Letter of Transmittal, 7 

Ungraded Classes 20 

Selection of children for examination ][[[ 20 

A study to establish facts ..V.. 21 

Children's Court cases ' 22 

Mental surveys 22 

Psychiatric examinations 24 

Visiting teachers 26 

Social service chart 28 

Statistical summary 29 

The problem " ' 3Q 

Recommendations " 39 

Open-air Classes 3]^ 

Dr. Baker's report 3I 

Classrooms 3I 

General regulations ' 3I 

Feeding 32 

Home conditions ^2 

Rest period ^^ 

Supervisor ^^ 

Progress of work ^ ^^ 

Statistics 34 

Improvement of children 35 

Scholarship record 35 

Medical supervision : .---. . .- 36 

Results of work . . ; . 7. ;';'. 35 

Summer vacation 37 

Conclusions S7 

Miss Smith's report 38 

Out-door classes 38 

Type of classroom .• 39 

Classroom equipment 39 

Personal equipment 39 

Number and types of out-door classes 41 

New classes 43 

Open-air classes 43 

Type of case 44 

Location of classrooms 44 

Vetitilation and temperature 45 

Classroom equipment 45 

Personal equipment 45 

Rest period and diet 47 

Cleaning personal equipment 47 

Hospital record cards 50 

Number of classes SO 

Open window classes 51 

Location 52 

Structure 52 

Ventilation and temperature 52 

Type of case 52 

Recommendations 53 

Prophylactic Treatment 55 

Type of case 55 



PAGE 

Working group and control group 55 

Clinic records 56 

Diet 56 

Physical defects 57 

Dental inspection 57 

Rate of incidence of tuberculosis 58 

Results 58 

Pretuberculous children in the public schools 59 

Summary 60 

The Blind and Sight Conservation Classes 61 

Distribution of classes 61 

Eye clinics 62 

Production of textbooks 63 

After school records 64 

Manual work 64 

War activities 65 

Function of the sight conservation classes 65 

Recommendations 66 

Miss Smith's report 68 

Specialized physical training 68 

Sight conservation classes 71 

Hygiene suggestions 12> 

Classroom equipment 12) 

Summary 74 

Dr. Beals' report 75 

The work 75 

Candidates for sight conservation classes 76 

Progressive myopia 11 

The lens of the eye' 78 

Need of glasses 79 

Need of propaganda 80 

Refraction 80 

Ungraded children 81 

Handicap to normal children 81 

Results 82 

Whitman's views 83 

The Deaf 85 

Growth of the school 85 

The semi-deaf 85 

Objections to attendance at P. S. 47 86 

Advantages obtained 87 

Statistics 88 

Nationalities in the school 89 

Classroom work 89 

Test for standards 90 

The physical side 90 

The alumni association 91 

Trade work 91 

Graduates 92 

Improvements 92 

Miss Smith's report 93 

Physical care' and specialized physical training 93 

Facilities and equipment needed 98 

Another teacher needed 98 

Summary 98 



PAGE 

Crippled Children Iqq 

Mrs. Scheider's survey 100 

Classes and register 100 

Classes in hospitals and convalescent homes 101 

The course of study 101 

Retardation 102 

. Transportation 102 

Causes of disability 102 

Noon day meals 104 

Prevocational training 104 

Character of the work .". . . 105 

Recommendations 106 

Conclusion 107 

Miss Smith's report 110 

History 110 

Growth 110 

Type of special classes Ill 

Special classes in public schools Ill 

Classrooms and equipment 113 

Transportation 113 

Day school 1 13 

Hospital classes 115 

Home instruction for helpless cripples 117 

Assignment of teachers 118 

Volunteer visiting teachers 121 

Results and inductions of poliomyelitis 122 

Summary 124 

Industrial and Placement Work 125 

Controlling purpose 125 

Aim 125 

Adjustment of time schedule 126 

Work in School for the' Deaf 127 

Teachers' training classes 128 

Cardiacs 129 

Miss Smith's report 129 

Formation of classes 129 

Type of case 129 

Hospital record card 130 

Co-operation bodies 131 

Admission and discharge 131 

Classroom temperature 131 

Feeding in school 132 

Morning hygietie inspection 132 

Daily medical inspection • 133 

School care 133 

School curriculum 134 

Routine school day 134 

After school recreation 135 

Tentative program for Saturday and Sunday 136 

Chart for general observation 136 

Results 137 

Recommendations 138 

Principal Marks' report 139 

Organization of classes in P. S. 64, Manhattan 139 

Classification 139 



PAGE 

Mothers' meetings 140 

Thoroughness of maintenance 141 

Mrs. Scheider's report 142 

Organization of classes as annex to P. S. 75, Man 142 

Enrollment 142 

Food 142 

Program 143 

Results 143 

Table of attendance 144 

Principal Smith's report 145 

Organization of class in Lenox Hill Settlement 145 

Clinics 145 

Food 145 

Rest 146 

Recreation 146 

Co-operating agencies 146 

Speech Improvement 147 

Teachers employed 147 

Work in evening and summer schools 147 

Clinics 148 

Army work 149 

Syllabus on foreign accent 149 

Re'commendations 150 

Parental and Truant Schools 151 

Buildings 151 

Physical and medical examination 151 

Daily life 152 

Grade work 152 

Activities and products 153 

Recommendations 155 

Commitments 156 

Value of productions 157 

The Manhattan school 158 

Probationary Schools 1^9 

Organization 159 

Causes of truancy and delinquency 161 

Physical defe'cts 162 

School lunch 164 

Garden 166 

Afternoon recreation centre 166 

S. P. C. C. annex 166 

Shop work 167 

Business methods 168 

Academic subjects 168 

Suggestions 169 

Visiting Teachers I'O 

Function and requirements I'O 

Assignment and supervision I'O 

Visiting teachers' individual report 171 

Visiting teachers' monthly report 1'^ 

Maladjustments in scholarship 174 

Conduct and prevention of truancy 177 

Children kept in school 1' 9 

Americanization 180 

Suggestions 1°1 



LETTER OF TRANSMITTAL 



July 12, 1920. 
TO THE BOARD OF EDUCATION. 

Ladies and Gentlemen: 

I submit herewith the report of Associate Superintendent Ed- 
son, dealing with special classes. The report also deals with the 
work of truant and probationary schools, and the work of visit- 
ing teachers. 

Perhaps the most characteristic advance in school administra- 
tion during recent years has been the rejection of the assumption 
that all children are practically alike in physical and mental 
equipment, and also that children with marked physical defects 
of sight, hearing or limb have no place in the public schools. Un- 
der the older belief, children of widely different abilities were 
grouped together in unit classes, with the result that physical and 
mental defectives were very frequently laggards because of their 
inability to take advantage of the instruction offered. The child 
with defective vision, the stammerer, the cardiac, and the mental 
defective were placed in severe scholastic competition with prac- 
tically normal children. The net result of their failure was not 
only extreme personal discouragement and loss of self-esteem and 
self-confidence, but also considerable expense to the city, because 
of the fact that such children were repeaters in the grades. The 
proper classification and segregation of such children was there- 
fore desirable, not only from a humanitarian, but also from an 
economical standpoint. 

I am sure that in the future we face an expansion of this type 
of service, because increased diagnostic skill will make it possible 
and also imperative that children be grouped in accordance with 
their physical and mental ability, so that unfair demands will not 
be made upon them, and also so that they can derive the maximum 
benefit from the educational facilities offered. While the present 
emphasis is upon the care of the subnormal type of child grouped 



8 

in so-called ungraded classes, it is equally certain that in the fu- 
ture grading of our children we will have to make definite pro- 
vision for the superior type of child. As I have already stated 
in discussing this problem, a desirable type of school organization 
where grade registers are sufficiently large to permit such group- 
ing, is one in which the total group in a given grade is sorted out 
into class units of precocious, average, and subnormal children in 
terms of native ability as well as scholarship. Pupils grouped in 
this way, if handled by skillful teachers, are happy and contented 
because they are working within their normal limits of ability. 
As the result of such grouping, the teacher, if allowed to adjust 
the course of study to the needs of the pupils, can do much more 
effective work than is possible in a class composed of pupils of 
markedly uneven attainments. It is too radical to urge that chil- 
dren properly grouped and working through a course of study 
adapted to their ability, would never be left back in the grades? 
Is it not true that the percentage of holdovers and leftbacks is at 
least a partial index of the crudity of school management and our 
ignorance of childhood? 

Indeed, the development of a finer classification of our chil- 
dren implies the extension of the ungraded class system far be- 
yond its present limits, and also other groupings that the present 
ungraded system does not include. Children of a precocious type 
are entitled to just as much consideration as those of a subnormal 
type. We have made an excellent start, but a very limited one, 
in the mastery of the entire problem. 

Probably no type of class or child makes a stronger appeal to 
the general public than the ones with which this report deals. The 
various partial reports show with considerable detail the pro- 
visions made for the blind child, who formerly groped around his 
home, making no progress and developing all kinds of unfortu- 
nate mannerisms ; for the deaf child, who either remained at 
home or struggled ineffectively in the classroom ; for the child 
afflicted with a cardiac lesion who formerly was compelled to 
comply with all the exacting demands made with reference to dis- 
missals, gymnastics, book work, despite his disability ; for the 
crippled, who either remained at home after infantile paralysis 
had afflicted him, or who struggled manfully in a school room 



equipped with furniture which was totally unsuited to accommo- 
date him; for the speech defective, whose stuttering and stam- 
mering made him an object of pity or ridicule, both in his school 
and in his social environment ; and for the mental defective, whose 
inability to respond as a member of a normal class begat nagging, 
which in turn eventually drove the child to truancy. Backward 
indeed would be any educational program that did not include 
within its benevolent scope ample provision for such types of 
handicapped children. 

A careful consideration of the problem of the exceptional child 
convinces me that there will always be need of a system of par- 
ental and probationary schools to handle those children who, 
either because of bad habits resulting from defective mentality or 
from unfortunate social environment, or the combined influence of 
both, are so vicious or unsocial in their behavior that it is necessary 
to place them under more or less restraint in order that they may 
not contaminate decent children, and in order that, through proper 
care and instruction, they shall be, trained in habits of hygienic 
living and orderly behavior. The proper execution of this plan 
would involve the establishment throughout the city, in definite 
relation to the needs of the school population, a system of proba- 
tionary schools in which, through compulsory attendance rigidly 
enforced, longer hours, a varied school curriculum including pre- 
vocational training and such coercive measures under wise limita- 
tion as may be deemed necessary, these exceptional pupils would 
be trained so that after a reasonable period they could be returned 
to the average public school. The initial step in this matter has 
been taken, and the gradual development of such a system of 
schools is one for which financial provision should be made just 
as soon as it is possible to relieve existing congestion, and thus 
make certain buildings available for this purpose. 

The problem of the visiting teachers, especially their salary 
status, is one that has aroused a good deal of heated discussion, 
much of the difference of opinion growing out of the lack of 
definition of the function of the visiting teacher. Some go so far 
as to claim that the title is a misnomer because little if anv teach- 
ing is done bv the so-called visiting teacher. Others claim that 
such work is a very essential part of their daily routine, and go 



10 

so far as to claim that the person serving in such capacity should 
be a highly qualified teacher with training in social work, and 
should be paid as great a salary as a teacher holding a promotion 
license. If we were to concede the truth of this contention, it 
would seem to be reasonable to claim that the visiting teacher 
should be recruited from the teaching staff, and that she should 
hold a basic grade license and also a promotion license. 

I am inclined to believe that the truth of the matter is that the 
so-called visiting teacher is primarily an adjuster of certain social 
situations, and is entitled neither to the status nor to the salary of 
teachers who have, as the result of competitive examination, 
gained basic teaching licenses, and who daily face the exacting 
routine of classroom instruction. As social adjusters, the visiting 
teachers' most valuable service will no doubt always be rendered 
in the case of adolescent girls in unfortunate environments. It is 
conceded that our present visiting teachers operating in this par- 
ticular field have done remarkably fine work, and have filled a 
real gap in our educational service. Whether or not visiting 
teachers, as a group, shall be made an integral part of the Bureau 
of Attendance and Child Welfare is a mooted question, and will 
be decided in the light of experience. 

In conclusion, I wish to take this opportunity to extend to the 
Board of Education my sincere appreciation of the intelligent in- 
terest in these special classes that has been the basis of an insis- 
tent demand on the part of the Board that these activities receive 
adequate financial support. 

Very truly yours, 

WILLIAM L. ETTINGER, 
Superintendent of Schools. 



11 

DR. WILLIAM L. ETTINGER, 

Superintendent of Schools. 

Dear Sir : 

I submit herewith reports for the past three years on special 
classes in our pubHc schools, including the education and training 
of mental defectives; of the blind, deaf, and crippled children; of 
children having speech defects ; of children in the truant and pro- 
bationary schools ; and reports of the visiting teachers. 

MENTAL DEFECTIVES 

Miss Farrell, Inspector of Ungraded Classes, calls special at- 
tention to one of the great problems in school administration — 
the proper identification and treatment of children of low or re- 
tarded mentality. The results of the mental surveys of men in 
the army disclosed the fact that of the 1,726,(X)0 men examined, 
five-tenths per cent were reported for discharge because of mental 
inferiority, six-tenths per cent were assigned to development 
battalions in order to be carefully observed and be given a pre- 
liminary training for use in the army, and 3 per cent were found 
to be under 10 years' mental age. The facts disclosed have ex- 
cited much discussion among educators of this country, and, as 
a result, increased attention is sure to be given to the education 
and training of children of low mentality. 

The extent of the problem may be seen from the estimate made 
by two of the best authorities in this country, Dr. Walter E. 
Fernald and Dr. Louis M. Terman, who estimate that 2 per cent 
of the population are of low mentality. On this basis, 14,760 
children in the schools of this city should be in ungraded classes, 
only about 28 per cent of whom are now in such classes. The 
recent tests given men, applying or drafted into service in the 
army, gave a much higher percentage than 2 per cent. The prob- 
lem is a large one and calls for a liberal appropriation. 

One phase of the work, brought to our attention in this report, 
is the fact that 222 elementary school principals in control of 321,- 
900 children, approximately, neglected to report any children for 
psychological and psychiatric examination. The school principals 



12 

sympathetic in the matter of individual differences, reported from 
1 to 5 per cent for examination. Miss Farrell recommends that 
all cases of truant and incorrigible children be subjected to a 
mental examination before any disposition of their case is made. 

In any consideration of the problem of the education and 
training of children of low mentality, attention is called to the 
fact that the Lockwood law of 1917, which went into effect in 
1918, requires the education of children with retarded mental de- 
velopment. The passage of this law, making compulsory special 
education for mentally retarded children, imposes a burden and a 
responsibility upon the school authorities of this city. 

One of the most serious problems in connection with the edu- 
cation and training of children of low mentality is the inability to 
secure properly trained teachers for the work. Many teachers 
are unwilling to be assigned to such classes, and many others are 
poorly prepared to give these children the training they need. The 
lack of preparation is especially evident in lines of manual work, 
the very field in which all the teachers should be strong. 

OPEN AIR CLASSES 

Dr. S. Josephine Baker, Director of the Bureau of Child 
Hygiene, submits a brief summary of the work carried on by the 
Board of Health in connection with open air classes. One notice- 
able result of this work was found in the average gain in weight 
of children in the open air classes. This gain was more than 
eight and a half pounds, and it was noticed that the lower the 
temperature, the greater the gain, due largely, no doubt, to the 
fact that the appetite is markedly increased in cold weather. 

The school progress of children in open air classes was found 
to be very satisfactory. Dr. Baker asserts, "It has been conclu- 
sively proven that children who are subnormal physically, when 
afforded an opportunity to receive fresh air, light, and food, to 
have their physical defects, which retard growth and development, 
corrected, and to live under proper hygienic conditions, can be re- 
stored to at least normal physical condition." 

Miss Smith. Assistant Director of Physical Training, presents 
a report on the outcome of the results obtained through open air 



13 

treatment of cases of incipient tuberculosis, and of those predis- 
posed to respiratory diseases. She considers the type of open air 
classes, the location and structure of classrooms and equipment 
needed, the value of lunch service for these children, the hospital 
and physical training records called for, and the prophylactic 
treatment of pre-tuberculous children in the Stuyvesant clinic. 

The work carried on in the three types of fresh air classes — 
the open window, the open air, and the classes of children affected 
with tuberculosis — is proving a Godsend to thousands of children 
in our schools. The open window classes call for no additional 
equipment. The ventilating system is cut off from the rooms so 
that the circulation of fresh air is through the open windows. The 
children are allowed to wear their outer wraps as desired, and the 
temperature is not allowed to go below 50°. 

The open air classes have, or should have, sunny rooms, in- 
dividual study chairs, cots for an hour's rest during the day, 
sleeping bags, sweaters, caps and mittens, and a warm noon 
lunch. 

The classes for tuberculous children are located at sanatoriums^ 
on the roofs of hospitals, or on abandoned ferry boats. These 
classes receive daily medical treatment, a warm noon lunch, two 
mid-session lunches, and opportunity for rest. 

There are today 110 open air classes — 57 in A^anhattan, 8 
in the Bronx, 34 in Brooklyn, 10 in Queens, and one in Richmond. 
There is an imperative demand for a large increase in the number, 
but the increase cannot be made unless proper equipment can be 
provided. In fact, 37 of the classes already organized are in need 
of suitable equipment, in whole or in part. If funds and rooms 
were available we could organize to advantage 100 new classes. 

There are at present 25 out-door classes of tuberculous chil- 
dren in sanatoriums, hospitals, and on abandoned ferry boats, as 
annexes to nearby public schools, 17 in Manhattan, 4 in Brook- 
lyn, and 4 in Richmond. These children receive food and 
careful medical treatment. 

The reports are very illuminating and suggestive. Their rec- 
ommendations, as to the organization and conduct of open air 



14 

classes and the treatment of pre-tuberculous children are worthy 
of thoughtful consideration. Money and effort given to the bet- 
terment of these physically handicapped children are well spent. 



THE BLIND AND SIGHT CONSERVATION CLASSES 

Miss Moscrip, Inspector of Classes for the Blind, in her re- 
view of the work of the year in the treatment of blind and near 
blind children, presents an excellent view of the work accom- 
plished. She emphasizes the value of the eye clinic under Dr. 
Beals of the Board of Health, and calls special attention to the 
function of the sight conservation classes that are doing such ad- 
mirable work in saving the eyesight of so many children. The 
scarcity of suitable textbooks with enlarged type, and the great 
expense and labor involved in preparing these textbooks, are a 
great handicap to the work. 

The expense of transportation of the blind children and their 
guides to and from school is a necessary part of the education of 
these children, as many of them are obliged to travel long dis- 
tances to school where a class has been organized. 

There are at present 300 cases on file in the office of the In- 
spector awaiting assignment to sight conservation classes. 
Teachers and equiprhent for these children with defective eyesight 
are very much needed. 

Miss Smith calls attention to the value of specialized physical 
training of the blind from the segregated group toward the nor- 
mal through association with children in normal classes. She 
points out the fact that the blind and near-blind children are phys- 
ically able to take part in most of the physical training exercises 
of physically normal children, and she recommends that large, 
sunny, and well ventilated classrooms be provided for all blind and 
sight conservation classes in public schools. 

Dr. Beals makes a very interesting summary of the work of 
the eye clinic in P. S. 30, Manhattan. He examines the eyes of 
all candidates and assigns these children to blind, sight conserva- 
tion, or normal classes. He makes a full diagnosis and prognosis 
of each case, and outlines the kind and quality of work that may 



15 

be permitted for each child, and he suggests improvements in the 
conditions found, be it disease or refractive error. Some of the 
results obtained are very remarkable and very encouraging. 

THE DEAF 

Miss Kearns, principal of the School for the Deaf, presents 
the objections raised and the advantages obtained by attendance 
at a special school for the deaf ; statistics on the present condition 
of the school and the nationalities represented; the classroom 
work and tests for standards. 

The great need of the school is a suitable building, and the 
Board of Education has included a request for such building and 
site in the next appropriation. It is to be hoped that this build- 
ing will be erected in the near future, as the school is in great 
need of better accommodations. 

The work in the School for the Deaf, and the results attained, 
are deserving of the highest praise. This school is ranked as 
one of the best in the country. 

Miss Smith, in her report, emphasizes the need of special at- 
tention to be given to the health of physically handicapped 
children as the essential basis of their school life. She sta'tes that 
over 66 per cent of thei children in the School for the Deaf have 
become deaf through serious illness, and that as a consequence 
their vitaHty has become impaired. She urges that during the 
growing periods of these children they be given adequate physical 
training in order to overcome their physical deficiencies. 

THE CRIPPLED 

Mrs. Scheider, principal of Public School 75, Manhattan, was 
assigned at the opening of the spring term' to make a survey of 
the work carried on in the 78 classes of crippled children in the 
public schools of the city. She visited these classes two or three 
times during the term, and her conclusions are embodied in the 
report submitted. 

Mrs. Scheider calls attention to the need and value of proper 
physical training, including motor transportation of crippled chil- 



16 

dren to and from school and to and from hospitals, to the need of 
suitable food at noon, inchiding a glass of milk during the morn- 
ing and afternoon sessions, to the need of suitable braces, massage 
and electrical treatment, to a close co-operation between the home, 
the school, and the hospital, and to proper medical and surgical 
treatment. She makes a plea for the best possible educational 
advantage for all, a unified control, the standardization of forms 
of organization and methods, and a study of openings in industry 
for these children. 

In order to secure better results, it is clearly evident that there 
should be a great centralization of these classes, motor transporta- 
tion for all, greater attention given to curative gymnastics, and a 
proper and thorough industrial training given to all in order that 
they may readily engage in some useful and self-supporting em- 
ployment. 

Miss Smith, in her report, considers the four types of special 
classes for crippled children — special classes in various schools, a 
day school for crippled children, hospital classes, and home in- 
struction for helpless crippled children. The assignment of teach- 
ers to the homes of helpless cripples for instruction in elementary 
school subjects and in lines of industrial training is proving a 
Godsend to many children who would otherwise be entirely neg- 
lected. The three points that stand out most prominently in these 
reports are the need of : 

1. A greater concentration of classes 

2. Motor transportation 

3. An extension of the plan to provide teachers for helpless 
cripples at their homes. 

The expense for the education and training of crippled chil- 
dren looms large, but the problem is a big one. A recent survey 
made by a representative committee of physicians and specialists 
indicates that there are in this city about 36,000 cripples ; that 
about 50 per cent are under 16 years of age; that 63 per cent be- 
came cripples before reaching the age of 16; that nearly one-half 
of the cases discovered by a field canvass were not being treated ; 
that there are approximately in the city, 1,000 cases of poliomye- 



17 

litis, Potts' disease, and tuberculosis of the joints, not yet diag- 
nosed; that there are about 3,700 cases with these diseases that 
have been diagnosed but have ceased to attend clinics; and that 
over 50 per cent of cripples are not known to any agency. 

INDUSTRIAL WORK 

Miss Ronzone, special teacher in charge of the industrial and 
placement work of physically handicapped children, urges as the 
controlling purpose of her work the preparation of these children 
for useful employment in the trades. She states that it is the 
mission of the teacher to study the peculiar handicap and individ« 
ual tendency of each child in order to find occupational possibili- 
ties, and thus aid the child to be self-supporting and self- 
respecting. 

CARDIACS 

For the past two years, an experiment has been tried in the 
organization and conduct of classes of children having pro- 
nounced cardiac trouble, and during the past year very consider 
able emphasis has been given to the problem by the active co- 
operation of a committee of the Public Education Association 
and of the physicians in nearby hospitals. The special equip- 
ment provided, the examination of children by specialists, ihe 
daily routine of examination, work, rest, food, recreation are 
found in the accompanying report. The classes already organ- 
ized are made annexes to Public Schools 64, 70, 75, 168, 192, 
Manhattan, and Public School 34, Brooklyn. Other classes will 
soon be formed as suitable rooms can be found. The results so 
far secured are in the highest degree encouraging. 

SPEECH IMPROVEMENT 

Dr. Martin, Director of Speech Improvement, in his report 
of progress during the past year, gives a very encouraging 
statement of the work in his department. With his 26 special 
teachers at his clinics, he is able to render an excellent account 
of the service he is rendering to many young people of this city 
having speech defects. Three of his teachers rendered very 
acceptable service in army work. 



18 

Dr. Martin recommends that a central school be selected in 
each borough, at which acute cases of stammering may be iso- 
lated from other children. The idea appears to be an excellent 
one, as more time and effort could there be given to cases in need 
of prolonged and intensive treatment. 

In order to have the work properly carried on in all of the 
schools of the city, there should be a very considerable increase 
in the number of special teachers of speech improvement, at 
least one for each group of three or four schools, and five or six 
for the high schools and training schools. 



TRUANTS 

The principals and teachers in charge of the parental, truant, 
and probationary schools present interesting reports of the work 
of these schools during the past year. The Parental School, 
accommodating about 225 boys, is located on a farm of 107 acres, 
and the Brooklyn Truant School, accommodating about 120 boys, 
is located on a site comprising 14 acres, so that the boys in these 
two institutions get considerable outdoor Ufe and experience. 
The Manhattan Truant School, accommodating about 50 boys, 
is located in a brick building on East 21st Street, with no oppor- 
tunity for the boys committed there to get out-door work and 
exercise. The Parental School takes the older boys, while the 
Brooklyn and Manhattan Schools take the younger boys and 
transfer many to^ the Parental School from time to time as oppor- 
tunity offers and occasion demands. 

Provision has been made in the budget for 1920 for the 
erection and equipment of additional cottages at the Parental 
School, a cottage-home for the superintendent, an infirmary, a 
suitable barn and hennery. When these additions are completed, 
the Brooklyn and Manhattan schools can be closed and the 
property turned over to the city. The expense of the needed 
additions to the Parental School will thus be small, if anything, 
and the education and training of truants will be immeasurably 
improved, as well as a very considerable reduction in expense of 
management eflfected. 



■ 19 

The three probationary schools are serving a most excellent 
purpose in checking truancy and in leading boys to appreciate the 
advantages of an education. There should be a dozen such 
schools in this city. The need is great. 

A committee of the Teachers' Council submitted to the Board 
of Education last June a report urging the establishment of more 
probationary schools. The report closed with the following 
statement : 

The greatest waste occurring in school administration is that which 
arises when a school is compelled to retain among its pupils exceptional 
children whose physical, mental or moral condition is such that an ex- 
cess of time and energy must be continually bestowed upon them to the 
detriment of normal pupils, in order to secure the proper social and 
scholastic classroom environment in which instruction can be fittingly 
carried on, 

VISITING TEACHERS 

The six visiting teachers have continued their good work. 
They have had the assistance of four teachers of German on 
special assignment. The work is so important and so far-reach- 
ing that I feel justified in making a special plea for an increase 
in the number of such teachers. The visiting teacher is the 
co-operating agency between the school and home. Her work 
is to secure the hearty interest and support of parents in the 
schools, and thus in the most effective way to prevent truancy. 
She is one of the potent agencies in making good citizens ; she 
assists backward children to gain a promotion ;, she assists in 
making home adjustments so that children may be prompt and 
regular in attendance at school : she is a tremendous force in 
preventing children from becoming delinquents and criminals. 
The call from principals for the assignment of visiting teachers 
to their schools is loud and insistent. We could make good use 
of one in each of the 48 school districts. 

The accompanying reports are submitted for your careful and 
sympathetic consideration. 

Respectfully submitted, 

ANDREW W. EDSON, 
Associate Superintendent. 



20 

UNGRADED CLASSES 

Elizabeth E. Farrell, Inspector. 

SELECTION OF CHILDREN FOR PSYCHOLOGICAL AND 
PSYCHIATRIC EXAMINATION 

In a previous report it was recommended that a method be 
devised which will make practically certain the identification of 
all mentally defective children in the schools. Tiiey should be 
known early in their school careers in order that habits of tru- 
ancy in some children may not develop, that conduct disorders 
may, in part, be prevented, and that educational opportunity, 
commensurate with their needs and capacities, may be provided. 
Because of the significance for school administrators of the men- 
tal examination of men in the army, this recommendation is 
repeated. Mentally defective children are not identified by all 
school principals, notwithstanding the Superintendent has in- 
dicated certain t}pes of children who should be the objects of 
their study and for whom they should exhaust the resources pro- 
vided. Some of his suggestions are as follows: 

1. Children who may be mentally defective: 

a. Children who have gross conduct disorders — truants : 
those who seem to be incorrigible ; those who seem to 
show criminal tendencies ; those who are habitually ab- 
sent from school even for a half day at a time ; those 
who have "tantrums." 

b. Children who seem nervous — those who cry easily ; 
those who are easily frightened ; those who constantly 
move about ; choreic children ; those who have unusual 
anxieties ; epileptics. 

c. Children who seem psychopathic — those who do not 
play ; those who play with children much younger than 
themselves ; those who are over-conscientious, hyper- 
sensitive ; those who avoid companionship ; those who 
are irritable ; those who have shown a marked change in 
disposition. 



^1 

d. Children whose progress is unsatisfactory — those who 
show defeci in general information about the home, the 
school and the street environment; those who show 
marked muscular inco-ordination ; those who show de- 
fect in judgment, foresight, language, suggestibility. 



2. Children who are obviously mentally defective: 

The weakness of this method is obvious. It leaves to chance 
and to opinion the selection of children for examination. During 
this school year 222 elementary school principals in control of a 
school population of approximately 321,900 neglected to report 
children for psychological and psychiatric examination. The 
percentage of children reported by elementary school principals 
who are intelligent and sympathetic in the matter of individual 
differences varies from 0.1 per cent in some schools to 5 per cent 
in others. The presence in all schools of children who need this 
service is demonstrable in two ways — mental surveys made else- 
where have determined the incidence of mental abnormality in 
school children; agencies other than the school in contact with 
certain children have sought mental examination for them. 
Agencies like the Bureau of Attendance, the Red Cross, the 
Children's Court, physicians, are some of those at whose request 
we have examined children this year. Thirty-four of the 222 
public schools from which children were not reported for mental 
examination this year had on their registers children whose ex- 
amination was asked by one or more of the agencies named. 



A STUDY TO ESTABLISH FACTS 

The Bureau of Attendance reported for examination this 
school year, 1,188 children who, after repeated warning by the 
attendance officers, persisted in their truancy and were called 
with their parents for a hearing before the Bureau of Attend- 
ance. An intensive study* of 608 such children was made in 
order to establish some facts as to the mental status of truants. 



* The Mental Status of Truants, by Louise E. Poull. 



22 

The study shows the distribution of intelligence quotients as fol- 
lows: 

Intelligence Quotient *' Total 

40 50 60 70 80 90 100 110 120 

to to to to to to to to to 

49 59 69 79 89 99 109 119 140 

Number of Children 3 16 76 170 176 77 81 9 608 



From a study of the age and grade distribution it is apparent 
that 75 per cent of these truants are retarded from one to nine 
years in their school attainment ; that 44 per cent are of such 
mental calibre that it is extremely improbable that their mental 
development will ever exceed that of a child of 12 years of age. 

children's court cases 

A study of the records ( September, 1918 — May, 1919, in- 
clusive) of the Manhattan Children's Court, shows that 200 
public school children were diagnosed as mentally defective by 
the psychiatrist of the court. Seventy-three of them had previ- 
ously been diagnosed by this office. f 

The distribution of intelligence quotients for this group is as 
follows : 

Intelligence Quotient Unknown Total 

30 40 50 60 70 80 

to to to to to to 

39 49 59 69 79 89 

Number of Children 1 12 61 81 38 1 6 200 

The work of these two agencies indicates that the school is 
far from discharging its duty with regard to its poorly endowed 
children. It is futile to continue the present method. A more 
objective and scientific one must be devised. 

MENTAL SURVEYS 

Surveys of large numbers of school children indicate that 
about 2 per cent are mentally defective. Terman says4 "What 
ever intelligence tests have been made in any considerable 



* An intelligence quotient below 80 indicates mental abnormality. 
t Of this number 11 were referred to the court by this department. 
$The Measurement of Intelligence. Lewis M. Terman. 



23 

number in the schools, they have shown that not far from 2 per 
cent of the children enrolled have a grade of intelligence which, 
however long they live, will never develop beyond the level which 
is normal to the average child of 11 or 12 years. The large 
majority of these belong to the moron grade." Apply this per- 
centage to the total register of 222 schools from which no chil- 
dren were reported by the school principals this year, and it is 
apparent that 6438 children have been neglected. 

The results of the mental survey of men in the army are now 
available. This survey was undertaken because the army was 
thought of as a place for highly specialized educational training. 
The specific problem was to place the recruit where he could give 
the best service and where his training could be most economically 
and efficiently obtained. "It is obvious that efficient and economical 
training can be given only when the intellectual power, degree 
of nervous stability and the degree of self-control of individuals 
are known. One million seven hundred and twenty-six thou- 
sand were given psychological examinations with a view to deter- 
mining these elements in their makeup. Of this number, 7749 
(0.5 per cent) were reported for discharge because of mental 
inferiority; 9871 (0.6 per cent) were assigned to development 
battalions in order that they might be carefully observed and 
given preliminary training to discover, if possible, ways of using 
them in the army. 

"During this same period of six months, there were reported 
4744 men with mental age ratings below seven years ; 7762 be- 
tween seven and eight years ; 14,566 between eight and nine 
years ; 18,581 between nine and 10 years. This gives a total of 
45,653 (3 per cent) men under 10 years' mental age."* 

The simplification of methods of discipline and a decrease in 
the number of offenders came as a by-product of the mental ex- 
amination of recruits. The army experience shows that men 
with low intellectual power, when in squads or companies in 
which men of high intellectual power were present, chose to 
appear stubborn rather than stupid. When this fact was estab- 
lished, extreme or persistent violators of military rules were not 



* Major Robert M. Yerkes in Psychological Reviezv, March, 1919. 



24 

punished until the results of mental examination were available. 
This experience is similar to that common in ungraded classes. 
It will be true in all classes when individual mental differences 
determine school classification. 

The great majority of the men examined in the army are 
products of the public schools of this country. It is fair to 
assume that their school life could have been more efficient and 
more economical if their mental status had been known. Judged 
by the results of tests in the army, we have in the public schools 
of this city, 22,200 children who will never develop beyond the 
mental age of 10 years. Apply the more conservative percentage 
of Terman and we have 14,800 children who will never reach 
the mental development of the normal adult. There are ifl 
ungraded classes at present, 4126 children. 

PSYCHIATRIC AND PSYCHOLOGICAL EXAMINATION 

From the data, both practical and theoretical, submitted here, 
it is obvious that we are not identifying all the mentally defective 
children in the schools. This failure is due to the inherent 
weaknesses in the present method of selecting children for ex- 
amination. This method is based on subjective data. The 
new method must be based on objective, scientifically determined 
facts. A satisfactory method must be based on the following 
principles : It must eliminate chance and surmise in the selection 
of children for examination ; it must be practicable from the 
point of view of time and of expense; it must eliminate 
emotional factors in the selection of children; it must insure that 
every school shall know the extent of its problem of mental ab- 
normality. 

With this in mind, we have, during this school year, inaug- 
urated a new method of selecting children for special education. 
A mental survey of two public schools was made. All of the 
children were measured in order that the school attainment, the 
intellectual power and the emotional control of each child might 
be known. This was made possible by the generosity and scien- 
tific interest of Professor W. A. McCall and of Professor Leta 
S. Hollingworth of Teachers' College; and by friends of the 



25 

children who provided funds for additional psychological, statis- 
tical and clerical help. The results show that one child in three 
is classified according to his ability to do school work. The fol- 
lowing statements will serve as illustrations : 

Measured by the Thorndike Reading Scale, it was found that 
the best pupil in the 3A class made the same score in reading as 
the poorest pupil in the 8A class ; there was every degree of 
overlapping of reading ability between these two extremes. 
Measured by the Trabue Completion Language Scale, the four 
best pupils in the 4B class made exactly the same scores as the 
three poorest pupils in the lOB class. The best speller in the 3A 
class could spell the same number of words of the Ayres Scale 
as the poorest speller in the 8A class. Measured by the Woody- 
McCall Mixed Fundamentals in Arithmetic, the best pupil in the 
3A class made a higher score than the poorest 8B pupil. Eigh- 
teen (3 per cent) of the group were found to be mentally defec- 
tive. Eleven of these were wasting their time, as well as the 
time of the other children in their classes, and of the teachers, 
in grades from 5B to 9A. This fact was unknown previous to 
the survey. Sixty were children of borderline intelligence. As 
well as these stupid children, the survey revealed the fact that 
eight children were of superior intelligence, while 14 were far 
above the average. A table, showing the reclassification of the 
SB class "on the basis of ability to do school work," is given be- 
low, and will serve to illustrate what was found throughout the 
school: ^^3LE 



RECLASSIFICATION 


OF 


8- 


-B GRADE. 




Assigned to : 






No. 


Children 


Ungraded 








1 


Special 








2 


7a 








1 


8a 








7 


8b 








7 


9a 








3(1 ps3'chopathic) 


9b 








2 


lib 








3 


12b 








1 



27 

AGE RANGE 12j4 TO 17 YEARS. 



26 



REPORT OF VISITING TEACHERS 



The time of the social service staff is divided approximately 
as follows : 



Visits 

Clinics 

Records 

Statistics 

Interviews 



VISITS 

Visiting occupies about one-half the time. The usual object 
of visiting the home is to ascertain what the conditions are and 
to endeavor to correct or modify any influences which are ad- 
verse to the child's welfare. Sometimes the chief purpose of 
the call is to talk with the mother on some special subject. 

School visits are made to talk over with principal or teacher the 
special problem of the child. Miscellaneous visits include calls 
at hospitals, Children's Court, relief agencies, and so forth. 

Of all the cases visited, 53 per cent were visited once, 22.5 
per cent twice, and 24.5 per cent three times or more. Visits 
are made at all hours of the day, whenever the family can be 
found at home. Sometimes the call must be made in the even- 
ing, at the lunch hour, or on Sunday. 

The total number of visits made was 1217. Of these 711 
were home visits, 186 were visits to schools, and 320 were miscel- 
laneous.* 

CLINICS 

The work of the visiting teacher at climes consists first of 
taking from the parent who accompanies each child, a careful 



*The figures represent the work of the school year, May and June 
work being estimated on the averages of the previous eight months. 



27 



history of the early life, and of the hereditary and environmental 
influences; secondly, in talking with the parent at the end of the 
examination and summing up the recommendations made. 
Many parents who bring their children for examination have 
never heard of an ungraded class. The purpose of ungraded 
classes must be explained in order to secure the parents' co-op- 
eration. Recommendations for physical care must be talked 
over, and the parent told where to go for the treatment indicated. 
A careful interview at the time of the parent's visit to the office 
frequently makes a home visit unnecessary. 

Two hundred and eighty-seven clinics of one-half day each 
were held in the department, each of which was attended by one 
or more of the visiting teachers. 



RECORDS 

Full and accurate reports of all visits are made. Even 
interviews and telephone calls must be recorded in order that the 
file of each child may be complete. The records of each case, 
therefore, show exactly what has been done to date. 



STATISTICS 

The social work is, as occasion arises, put into statistical 
form. Sometimes it is desirable to present the data graphically. 
We regret that more time cannot be given to this part of the 
work, for the wealth of material in the files of the department 
would be of great scientific value, if it could be prepared for 
reference. 

INTERVIEWS 

Aside from the talks at the clinics, the visiting teachers give 
much time to interviews in the office. Relations, teachers, social 
workers, and sometimes the children themselves, come for ad- 
vice and information. 



28 

The relation of the social service to the rest of the depart- 
ment is shown in the accompanying chart : 



SOCIAL 



SERVICE 



SOURCES 



TYPES 



SCHOOLS RELATIVES SOCIAL AGENCIES CHILDREN'S COURT ETC 



DEPARTMENT OF 
UNGRADED CLASSES 



AGENCIES 




The number of new cases cared for was 410. Of these 272 
were boys and 138 were girls. In addition, 112 after-care cases 
were visited, the majority of these requiring only one call. 

More attention has been given to the correction of physical 
defects than ever before. It is hoped that many children pro- 
posed for ungraded class work may be able to maintain them- 
selves in the grades if physical handicaps are overcome. 

We attempt to provide social and recreational facilities for 
these difficult children in order to aid them to their fullest moral 
development. 

From September to May, 29 children w^ere sent to institu- 
tions for the feeble-minded. These w^ere either so unstable as 
to be a menace to society, or of such low grade mentality that 
they could not well be cared for at home. 



29 

Through the generous co-operation of such agencies as the 
Society for the Prevention of Cruelty to Children, charitable or- 
ganizations, Children's Court, hospitals and settlements, we have 
been able to accomplish more than could otherwise have been 
possible. 

The 5000 children annually referred to this department can- 
not be cared for adequately by only three visiting teachers. 
Many psychopathic children are examined. These require the 
most watchful care, and with our present staff can be given but 
little attention. Many cases referred to hospitals and social 
agencies cannot be followed up as they should be to make sure 
that recommendations are carried out. Time is required for 
more intensive work with individuals. After-care work, which 
is so necessary for the mentally defective, is hardly touched 
upon. 

In order that the social service of the department may at- 
tempt to cope with the demands made upon it, at least two ad- 
ditional visiting teachers are urgently needed. 



TABLE 

STATISTICAL SUMMARY 
ANALYSIS OF 1672 NEW CLASSES SEEN BY PSYCHIATRISTS 

1919-1920 

Ungraded Not Ungraded 

Total Total 

Age.. 5-8 8-12 12-16 Age.. S-8 8-12 12-16 

Sex.. B. G. B. G. B. G. B. G. Sex.. B G. B. G. E.G. B. G. 

Man. 16 23 176 96 149 93 341212 Man. 40 22 13867 47 41 225 130 

Bronx 6 5 28 17 20 6 54 28 Bronx 8 3 33 6 13 1 54 10 

Bklyn 28 7 119 54 81 39 228 100 Bklyn 23 9 90 22 32 2 145 33 

Qu'ns 1 14 10 9 13 24 23 Qu'ns 3 2 18 3 2 3 23 8 

Richd 11 6 8 11 18 9 Rich'd 3 1 12 4 3 

Total 665 372 451 184 

Grand total 1037 635 



30 
TABLE 

STATISTICAL SUMMARY OF NERVOUS 
AND MENTAL DISORDERS 

Disease . Constitutional 

T3^„: Functional r, u i.u- it -i Glandular 

Brain Psychopathic Epilepsy 

/-,, • Psychoses t f • v Dysfunction Total 

Organic •' Inferiority -^ 

37 28 25 33 19 142 



THE PROBLEM 

800,000 public school children 
22,200 who should be in ungraded classes 
4,126 children now in ungraded classes 

For every 200 school children approximately 5 are in need 
of ungraded class work. At present only 1 of these is cared 
for in an ungraded class. 

RECOM MENDATIONS 

The work which has been carried on this year dictates the 
following recommendations : 

1. The position of education psychologist should be author- 
ized in the office of the inspector of ungraded classes. 

2. Two additional clerical positions should be authorized. 

3. Two additional visiting teachers with training and experi- 
ence in psychiatric social service should be provided to continue 
the work which the American Red Cross has begun in connec- 
tion with this office, and which is concerned with children of 
school age who cannot attend school because of the degree and 
complexity of the defects from which they sufifer. 

4. Following tiie army procedure cases of gross misconduct 
which do not yield to ordinary measures of school discipline 
should have a mental examination before any disposition is 
made. 

5. Provision should be made for the examination of all tru- 
ant children. 



31 

OPEN-AIR CLASSES 

S. Josephine Baker, M. D., D. P. H. 
Director, Bureau of Child Hygiene. 

I beg to submit the following report of the work performed 
by the Bureau of Child Hygiene of the Department of Health 
during the school year 1918-1919, in connection with the 
open-air classes of the public schools. The number of open-air 
classes has been increased to 110 during the year. Though 
many more classes are needed and desired, so few satisfactory 
rooms are available that the increase must be slow until an ample 
number of suitable classrooms can be procured. 

CLASSROOMS 

The present location of classrooms can be divided intO' three 
general groups : first, the public parks ; second, on roofs of pub- 
lic school buildings and other buildings ; and third, in classrooms 
in public schools. 

^ The best location for these classes is in the school building, 
particularly if the customary structural changes have been made. 
Such classrooms answer all the requirements demanded for this 
work, and have none of the short-comings of the other two 
groups. They are cheaper and easier to maintain, require less 
equipment for the children, weather conditions do not interfere 
with the class routine, and therefore the work can be carried 
out properly every day. 

GENERAL REGULATIONS 

The nurses and teachers strive to have the parents procure 
proper medical treatment for their children. Because of these 
efforts, very rarely does a parent refuse or fail tO' have his child 
placed under proper medical care. Unfortunately, the facili- 
ties for providing medical care were greatly reduced this year, 
and many children were not able to receive the attention they so 
anxiously sought and desired before the close of the school year. 
However, arrangements have been made to care for many of 
these children at the various hospitals during the Summer va- 
cation period. 



32 

Great efforts are being made by the nurses and teachers to 
have the parents carry out, at home, similar routine to that con- 
ducted at the school. This is particularly emphasized as re- 
quired on the days when there are no school sessions. The 
parents are instructed to have their children observe the rest 
periods, and to provide their children with extra feeding on 
these days. We have been able to demonstrate that many of 
the children who failed to progress satisfactorily, improved 
readily and rapidly after the above routine was established at 
home. The parents have been urged to carry out this routine 
during the Summer, as it is hoped to prevent these children re- 
turning to school in the Fall with a great loss in health, which 
has been the unfortunate experience of the past. 

FEEDING 

Extra feeding has been provided in all the classes. In the 
Boroughs of Brooklyn and Queens, all deficits have been met by 
the Tuberculosis Committees of those Boroughs. In Manhat- 
tan and the Bronx many of the open-air classes were unable to 
procure funds from the usual sources, and the teachers were 
urged to have the cliildren bring food from home for their extra 
feeding period. This plan met with great success, and fre- 
quently the children would bring their own food from home and 
eat a liberal portion. The results show that this method of 
feeding is equal to any other plan, provided the children respond 
to the request and ])ring the proper food, as they did this year. 
Some of the teachers have found that there was more actual gain 
with this method than when the school provided the food. 

HOME CONDITIONS 

The nurses and teachers have paid a great deal of attention 
to the home conditions. On their visits to the homes, they 
strive to have proper hygienic conditions established, particularly 
for the pupils of their classes. To overcome all the obstacles 
they find in the homes entails a great deal of social service work 
for the nurses and teachers. This they have done willingly, 
and they have come to realize that this is a very important phase 



33 

of the work. Though a great deal has been accomphshed dar- 
ing the past year, the greater part of the work is still to be done, 
as funds have been very limited. 

REST PERIOD 

The morning rest period has continued to give the good re- 
sults previously noted. Though there are still a few teachers 
who find the afternoon rest period of equal value, the vast ma- 
jority now definitely state that the children benefit more, both 
from the pedagogical and the health points of view, with the 
morning rest period, and that it is superior in every way. The 
parents are urged to have their children observe a short rest 
period before the evening meal. 

SUPERVISOR 

The Supervising Inspector of Open-Air Classes and the med- 
ical inspectors gave talks to the parents on subjects that relate 
to the important factors that assist in bringing these children to 
normal physical condition. The nurses, too, attended parents' 
meetings and frequently gave talks on subjects brought to t'leir 
attention when visiting the homes. The teachers assisted at 
these meetings and co-operated in instructirg the parents, in 
getting the children under treatment, in correcting hom^ cond"- 
tions, and in general social service work. 

The Supervising Inspector of Open-Air Classes, in conjunc- 
tion with the Department of Physical Training, gave the teachers 
of these classes a course of lectures designed to promote a bet- 
ter understanding of this work, and to assist them in carryi^-g 
it out intelligently. 

PROGRESS OF THE WORK 

The amount of work performed by the Bureau of Child 
Hygiene during the school year 1918-1919 is shown in the tables 
that follow. The work was interfered with to a slight extent 
by the influenza epidemic, as many pupils and some teachers 
were absent at that time, 



34 

WORK IN OPEN-AIR CLASSES — STATISTICS 

1918-19 

Number of schools with open-air classes 78 

Number of open-air classes 110 

Register of classes 2,705 

Number of pupils examined 3,388 

Boys 1,423 

Girls 1,%S 

Number found with defective vision 451 

Glasses obtained 372 

Number found with defective hearing 36 

Treated 27 

Number found with defective teeth 1,811 

Treated 1,134 

Number found with defective nasal breathing 396 

Treated (operation) 161 

Number found with hypertrophied tonsils 478 

Treated (operation) 201 

Number found with defective nutrition 2,855 

Improved in open-air classes 2,618 

Number found with cardiac disease 96 

Treated 96 

Number found with pulmonary disease 72 

Treated 67 

Number found with orthopedic defects 86 

Treated 86 

Number found with nervous affections 31 

Treated 31 

Total number of children discharged from classes 683 

Total number of pre-tubercular children 628 

Total number who gained 3,151 

Total number who did not gain 214 

Total number who lost 23 



WORK OF MEDICAL INSPECTORS 

Inspections 743 

Regular physical examinations 3,688 

Re-examinations 9,674 

WORK OF NURSES 
Contagious Diseases : 

Inspections 45,167 

Instructions and treatments 12,344 



35 



Physical defects : 

Instructions at school 12,545 

School consultations with parents 1,612 

Cases terminated 926 

Visits : 

For contagious diseases 394 

For p'hysical defects 4,639 

To dispensaries 241 

To lectures 237 



IMPROVEMENT OF CHILDREN 

The method of weighing- the children has improved and is 
now uniform, so that the data is accurate. No child is consid- 
ered to have improved unless a gain of at least half a pound a 
month is made. , The average gain during the year was more 
than eight and a half pounds. Those who had not made a 
normal average gain were studied by the medical inspectors to 
ascertain the cause of the failure to gain. In most instances 
this was remedied and a gain quickly established. 

The children show a proportionate gain according to t'l^e 
temperature — the lower the temperature, the greater the gain. 
This seems to prove that it is not only fresh air, but also a low 
temperature that is required to procure a rapid gain in weight. 
This appears to be due to the fact that the appetite is remarkably 
increased during cold weather. With the first signs of Spring, 
the children fail to gain as rapidly, and one can readily deter- 
mine that their appetites immediately decrease. This is an ob- 
servation that has always been noted by those closely following 
this work. 

SCHOLARSHIP RECORD 

The school progress of the children in the open-air classes is 
perhaps best demonstrated by the following table, the data for 
which was supplied by the teachers of the open-air classes : 

Grades advanced Progress as compared to previous 

record 
More than Less than More At More 

one grade One grade one grade rapidly same rate slowly 

277 28^ 309 840 2^520 ^ 



36 



MEDICAL SUPERVISION 



The medical supervision was conducted in the same manner 
as last year. The inspectors and nurses were given a course of 
instruction by the Supervising Inspector of Open-Air Classes. 
The work was conducted more uniformly and with more intelli- 
gence after their experience of a few years with this work. The 
waiting lists were maintained in every school so that vacancies 
could be filled at once and full registers maintained throughout 
the entire year. 

Discharges from open-air classes are made at the mid-term 
promotion time and at the opening of school in September, be- 
cause it has been found that the children, on their return to 
school in September, are frequently not in as good physical con- 
dition as they were in June, when the schools closed. In such 
cases, many who were fit for discharge from the open-air classes 
in June must be re-admitted in September. This procedure has 
worked so satisfactorily that it is being continued this year. 



RESULTS OF WORK 

Last year a report was submitted of 367 children who were 
followed up after discharge from open-air chsses. These chil- 
dren were followed up again this year, and it has been found 
that every one of them has continued to remain in good phys'cil 
condition, able to carry out the work of his or her regular grade. 

This year 683 children were discharged from the open-air 
classes as fit to proceed in a regular class. Of this number it 
has been possible to follow up 491 to the end of this school yeir. 
with the following results : 

Cases Discharged from Open-Air Classes 

Gained Remained Lost Scholarship 

weight same weight weight improved Same Worse 

417 2 116 311 0~ 

It has not been necessary to return a single child, discharged 
during the year, to an open-air class because of loss in weight 



Z7 

or because the physical condition became so bad that they were 
unable tO' carry out successfully the work in a regular class. 

SUMMER VACATION 

The Association for Improving the Condition of the Poor 
cared for 500 boys of the open-air classes at their Simmer camp 
at Southfield, N. Y., during the Summer of 1918, and 528 during 
the Summer of 1919. They are to do the same again this Sum- 
mer for a like number of boys. Those who had this splendid 
opportunity all showed the benefits of their stay in the country. 

The Tuberculosis Committee of the Boroughs of Brooklyn 
and Queens opened a camp on Long Island, and cares for 75 
girls of their Boroughs, all selected from the open-air classes, 
during the Summer of 1918, and 125 girls during the Summer 
of 1919. 

CONCLUSIONS 

It has now been conclusively proven that children who are 
subnormal physically, when afforded an opportunity to receive 
fresh air, light, food, to have their physical defects which retard 
growth and development corrected, and to live under proper 
hygienic conditions, can be restored to at least normal condition. 
Besides, during this time, they can receive proper education. 
One of the most satisfactory results procured in this work is 
that so many of the children continue to follow out the instruc- 
tions given them while in these classes, and that the older ones 
are able to institute similar conditions in their homes, to the ad- 
vantage of the rest of the family. This is proved by the fact 
that there is never any difficulty in having a sister or a brother 
of a former member of any open-air class, willingly, even 
anxiously, enrolled in one of these classes. 

All members of the Bureau of Child Hygiene whose work 
brings them in touch with the Open-Air Classes takes this oppor- 
tunity to express their thanks for the hearty co-operation of t^:e 
principals and teachers, the various committees on prevention of 
tuberculosis and their respective supervisors, who follow up this 
work so closely. 



38 



OUTDOOR, OPEN-AIR AND OPEN-WINDOW CLASSES 
Adela J. Smith, Assistant Director of Physical Training. 

OUTDOOR CLASSES 

Open-air schools and open-window classrooms in the public 
school organization are the outcome of the beneficial results ob- 
tained through open-air treatment of respiratory diseases, par- 
ticularly pulmonary tuberculosis. Educational hygienists and 
physicians have been influenced thereby to adopt similar meth- 
ods for the health, care and treatment of school children, who, 
by reason of tuberculous affections, poor nutrition and other de- 
bilitating conditions, make little progress ph} sically and mentally 
in the environment of the indoor type of classroom. 

Among the 800,000 children attending the public schools of 
the City of New York, there are thousands of physically handi- 
capped children. These include children aft'ected with pul- 
monary tuberculosis, bone, skin and glandular tuberculosis, and 
also pretuberculous children, i. e., those exposed daily to tuber- 
culosis in their homes. Besides these, there are hundreds of 
crippled children, anaemic, mal-nutrition and cardiac cases. 

Experience has shown that these children cannot attend the 
regular classes in public schools, with profit. Through experi- 
mental study, it has been found beneficial to care for their com- 
fort, health and school progress, through definite methods of 
segregation, in special classrooms, and to provide suitable per- 
sonal and classroom equipment and a relaxed curriculum. 

Owing to the various types of physical defects, and the dif- 
ferent method of treatment, these children cannot be grouped 
in one type of classroom. The segregation of the various 
groups of physically handicapped children in the public schools 
of the City of New York, for open-air treatment and physical 
care, has been arranged according to the type of case. Three 
types of classrooms are used — outdoor, open-air, and open-win- 
dow rooms. 



39 

TYPE OF CLASSROOM LOCATION AND STRUCTURE 

These special classrooms are situated outdoors and, in large 
cities, may be located on ferryboats and piers, in parks and on 
hospital roofs. Elevators should be provided when the roofs 
of buildings are utilized. 

Outdoor classrooms are partially protected from weather 
conditions by a roof, but the sides of the room are open. 

Provision should be made for a heated indoor warming room 
and lunch room. This should be located on the same floor, to 
eliminate stair climbing. 

Careful consideration of the dietary of physically handi- 
capped children, both at school and at home, is of prime impor- 
tance, and necessitates the co-operation of the teacher with the 
school nurse for home visits. 



CLASSROOM EQUIPMENT 

Movable chairs should replace fixed desks and seats. For 
tuberculous children, a specially constructed chair is recom- 
mended. These children are handicapped by a serious disease 
which is active, and they have, therefore, less strength to resist 
fatigue than any other group under open-air treatment. 

PERSONAL EQUIPMENT 

For the personal equipment, certain essential garments and 
coverings are recommended. This equipment includes a wind- 
proof outer garment with hood attachment, or an Eskimo coat — 
an outfit easily washed, and therefore sanitary. Over the shoes 
a foot covering is worn in extremely cold weather. This con- 
sists of sitting-out canvas-covered felt knee boots with felt in- 
soles. This covering is warm and well ventilated, in contrast 
to the rubber arctics sometimes worn, which make the feet cold 
and damp by causing excessive perspiration. 

Bloomers should be provided for additional warmth, if nec- 
essary. These are worn by the boys over their school clothing, 
and by the girls under the dress skirt. Sweaters, coats, caps 



40 




41 

and mittens should be provided by the parents, since these are 
articles of clothing commonly in use by all. 

An army blanket should be used on very cold days, or when 
the child is sleeping. It is hygienic because it is easily cleaned. 

NUMBER AND TYPES OF OUTDOOR CLASSES 

Outdoor classes have been formed in the five boroughs of the 
City of New York, as annexes to the nearest public schools. 

Seven hundred and sixteen tuberculous children are now 
registered in 28 classes. 

These outdoor schools are classified as : 

Day Camps 

Home Hospital Schools 

Hospital Open-Air Classes 

Sanitarium Open-Air Schools 

In the Day Camp Schools, the children spend the entire day 
at the school, and return to their homes late in the afternoon. 
The classrooms are located upon ferryboats and piers, and ii 
parks. 

The Home Hospital School is a unit consisting of apartment 
homes of tuberculous families. The children of these families 
are practically isolated through hygienic measures. The out- 
door classrooms are located upon the roofs of the Home Hospi- 
tals. The day is spent out-doors, and at night, this open-air 
treatment is continued by means of spec'ally constructed bed 
rooms. The food is prepared by an expert, and supplied to all 
the families, through a central kitchen in the hospital. 

The Hospital Open-Air Classes have been planned for tuber- 
culous children who require medical and surgical care in hospi- 
tals. These children attend these out-door classes during the 
day, and remain at the hospital until cured. The classrooms 
are located on the roofs and balconies of the various city hos- 
pitals. 



42 

The Sanitarium Open-Air School receives children in the 
early stages of tuberculosis. They are sick children, and are, 
therefore, allowed to have only a limited number of hours for 
mental work or physical activities. 



Borough 
Manhattan . 

Brooklyn . . . 



DAY CAMPS 
P. S. No. of Classes Register 



, 12 Annex 
151 Annex 
. 17 Annex 



Totals 



4 
3 
3 

10 



108 
87 
97 

292 



Location 

Ferryboat "Camp Hud- 
dleston,'" ft. Jackson St. 
Ferryboat "Camp Mid- 
dletown," ft. E. 91st St. 
Ferryboat "Camp Ruth- 
erford," ft. of Broadway 



HOME HOSPITAL CLASSES 
Manhattan 158 4 96 78th St. and John Jay Pk. 



HOSPITAL OUTDOOR CLASSES 



Manhattan . . 


, . . 141 Annex 


2 


59 




52 Annex 


1 


14 


Bronx 


, . . 30 Annex 


2 


45 


Queens 


. . . 58 Annex 


1 


35 


Richmond . . 


. . . 30 Annex 


4 


88 



Totals 



10 



241 



Roof, Vanderbilt Clinic 
House of Rest, Inwood 
St. Joseph's Hospital 
143d St. near Brook Ave. 
St. Anthony's Hospital, 
Woodhaven 
Sea View Hospital, 
New Dorp, S. I. 



Manhattan 



SANITARIUM OPEN-AIR SCHOOL 

14 Annex 4 87 



N. Y. Municipal San't'm, 
Otisville, N. Y. 



43 



NEW CLASSES 



The need for additional out-door classes for the care of tu- 
berculous children of school age is indicated by the statistics 
which have been compiled from the recent records of various 
cities. 

A summary of the conservative estimates of chief medical 
officers shows that 1 per cent are affected by tuberculosis of 
easily recognized forms. 

This estimate would indicate that 8,000 children of school 
age in the City of New York are tuberculous. The New York 
Board of Health has estimated that there are also from 4,000 to 
5,000 children under 15 years of age suffering from non-pulmon- 
ary forms of tuberculosis. This indicated that there are hun- 
dreds of tuberculous children of school age who requii^e school 
care and treatment similar to that provided through the various 
types of out-door classes of the public schools. 

At the request of the Superintendent of the Day Camp 
"Rutherford," an additional class has been recommended for 
this annex, to accommodate the tuberculous children waiting for 
admission to out-door classes. At present there are nearly 100 
children in outdoor classrooms at this Day Camp. 

The formation of these new classes should be the beginning 
of a movement for the extension of out-door classes throughout 
the City of New York in connection with the public school sys- 
tem. It should continue until every tuberculous child is under 
open-air treatment combined with medical and school care, in 
order that these unfortunate children may have every chance for 
an education under the best hygienic conditions. 



OPEN-AIR CLASSES 

Open-air classes were established in public schools at the re- 
quest of the Anti-Tuberculosis Associations, in order that pre- 
tuberculous children might build up their resistance to disease 
through prophylactic measures, and also be removed from the 
danger of infection during the day. 



44 



TYPE OF CASE 

Three special groups of physically handicapped children 
should be included under the type of case selected under this 
classification. 

The first group includes the pretuberculors children, that is, 
those exposed daily to tuberculosis in their homes, and also those 
suffering from gland and skin tuberculosis. 

The second group includes children in an arrested stage of 
pulmonary tuberculosis. The third group includes the so-ca'.led 
"anaemic" or malnutrition cases. 

While experience has shown that all these groups have been 
benefitted by open-air treatment in fresh air classes, nevertheless, 
when accommodations are limited, preference should be given to 
the pretuberculous group and the arrested cases, as the more 
seriously handicapped children. 

Fresh air classes in public schools were established primarily 
for pretuberculous children as a prophylactic measure in the 
crusade against tuberculosis. Malnutrition and anaemic cases, 
without a tuberculous history, should not be segregated with this 
other type of case or arrested cases of tuberculosis, as this means 
a needless exposure of physically unfit children to tuberculous 
infection. 

Recent experiments in the public schools of New York have 
shown that anaemic and mal-nutrition cases have been placed in 
open-window classes with much benefit, and since there is prac- 
tically no expense associated with this type of open-air treat- 
ment, all malnutrition cases without a tuberculous history 
should be assigned to such special classes. 

LOCATION OF CLASSROOMS 

The open-air classroom should be an indoor room, located 
not higher than one flight, in buildings without elevators, in or- 
der to eliminate excessive stair climbing for physically handi- 
capped children. 

The classroom should be a corner room, preferably, in order 
that direct ventilation may be obtained even in stormy weather. 



45 

It should have a southeasterly or southwesterly exposure, so 
that sunshine may be had practically all day for warmth and as 
a germicide. 

The window frames of the classroom should be fitted with 
horizontally hung, pivoted, sectional windows. By means of 
this type of window, adequate fresh air can be admitted, without 
producing drafts, and even in stormy or windy weather, the 
windows may remain open without discomfort to the children. 

VENTILATION AND TEMPERATURE 

Direct ventilation is used, and heat should be available drr- 
ing the months when artificial heat is used. Care should be 
exercised to prevent the temperature from exceeding 50° F., or 
going below 40° F, 

CLASSROOM EQUIPMENT 

Movable, adjustable desk-chairs should be used in fresh air 
classrooms. This type of furniture can be moved to one side 
of the room, and space is thus provided for the cots during the 
rest period. Furthermore, sufficient space may be obtained for 
specialized physical training, without climbing stairs to the gym- 
nasium or playground. This is an important consideration in 
the prophylactic treatment of pretuberculous children. 

The desk chair should be adjustable, so that when the chil- 
dren are clothed in additional garments for warmth, they may 
still be seated with comfort, and in a manner to encourage good 
posture. This is essential to the health of the child. The char- 
acteristic posture of the pretuberculous child — as the accompany- 
ing photographs show — is one with chest depressed, head 
drooped and scapulas and waist prominent. Therefore, part of 
the treatment of this type is to improve his chest expansion and 
chest capacity, in order to strengthen his lungs, and to encourage 
a strong, erect posture. 

PERSONAL EQUIPMENT 

The same type of personal equipment recommended for use 
in out-door classes should be used by the pretuberculous chil- 
dren in open air classes.- An equipment lighter in weight rnay 



46 




47 

be used, because the room temperature is higher. The wind- 
proof outer garment and the sitting-out boots are, therefore, un- 
necessary. Leggings made of blanket material, similar to that 
used for the Esquimo suits, may be used in extremely cold 
weather. 

REST PERIOD AND DIET 

Methods similar to those outlined for children in out-door 
classes should be observed in regulating the diet and rest period 
for those in the fresh air classes. 

Pretuberculous children are suffering from conditions which 
require rest during the day. They are liable to prolonged fa- 
tigue periods in the afternoon, and because of their tendency to 
tuberculosis, there is the possibility of an afternoon temperature. 
The rest period should follow the noonday meal in order to tide 
over this danger time in preference to having either mental or 
physical exertion. Furthermore, in special cases, the rest 
period after lunch can be prolonged for several hours, especially 
for children running an afternoon temperature, until the physical 
condition improves. This rest is often impossible to obtain at 
home. 

The temperatures of all children in fresh air classes should 
be taken as a basis for the time and amount of rest each child 
should have daily, 

CLEANING PERSONAL EQUIPMENT 

■Considerable difficulty has been experienced in fresh air 
classes in keeping sleeping bags clean and sanitary. Vacuum 
cleaning and beating have been tried, and while this removes the 
dust, it does not kill vermin. Furthermore, it does not clean 
the soiled portions of the bags, nor remove the danger of infec- 
tion when used bags are assigned to other children. By way of 
experiment last term, a set of bags were thoroiighly beaten, 
brushed and washed with warm water and soap. This produced 
a clean, sanitary bag at a reasonable cost. All the personal 
equipment this year were cleaned in this manner and stored in 
mothalene until the winter term. 



48 



RETURN TO OFFICE OF DIRECTOR OF PHYSICAL TRAINING 

157 East 67th Street. New York City 



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50 

HOSPITAL RECORD CARDS 

Children should be admitted to fresh air chisses on the basis 
only of a thorough physical examination. 

The results of this examination should be placed upon a 
clinic or hospital record card by the examining physician, as an 
official record whereby the school life of each child may be reg- 
ulated according to the plan of treatment required by the clinic 
or hospital specialist. These records form the basis of all rec- 
ommendations for the kind and amount of both physical and 
mental work a child may do. 

A clinic record card has been prepared by the Dej)artnient of 
Physical Training for use in open air classes. The record card 
will enable the specialist treating each child to state the diagnosis 
of the case and recommend the treatment and physical care he 
wants for his patient, so that the school may co-operate in this 
care intelligently. 

These cards should be renewed at stated intervals in order to 
keep in touch with the treatment of each child. Children not 
under treatment should be sent to the clinic in the district in 
which they reside, for expert examination and care. 

The nursing service of the school, through home visits, 
should co-operate with the physicians in charge of each case to 
aid in correcting physical defects and to obtain advantageous co- 
operation of the home with the school. 

It is useless to segregate groups of physically handicapped 
children unless persistent effort is made to overcome physical 
defects and obtain improved home conditions for the child in 
accordance with the treatment enforced in the school and clinic. 

NUMBER OF CLASSES 

There are now 116 fresh-air or open-air classes in five 
boroughs, with a registration of 2,726 children. 

The records of the Board of Health show that only 491 pre- 
tuberculous children were recommended for admission to fresh 
air classes last year, out of a total registration of 2,726. The 



""""' 51 

balance were malnutrition, anaemic and cardiac cases, and chil- 
dren with orthopedic defects and nervous affections. This 
would indicate that there are accommodations for approximately 
2,500 pretuberculous children at present for fresh air treatment 
in special classes. Discharged cases, therefore, should be re- 
placed by the pretuberculous children listed at the various tuber- 
culosis clinics of the Bureau of Preventable Diseases of the 
Board of Health. 

Even then, there are approximately 9,000 children associated 
with these clinics, according to the report of Dr. Copeland, Com- 
missioner of Health, who are not in a fit physical condition to 
benefit by the instruction of a regular class. 

Six additional fresh-air classes have been recommended for 
this year (1920) two in Manhattan, two in Brooklyn, and one 
each in the boroughs of Queens and the Bronx. 

Although this will increase the registration by approximately 
150 children, there are still many thousands of pretuberculous 
children listed at the tuberculosis clinics of the Board of Health 
and hospital clinics, in need of this special care. 

Last year no funds were allowed in the budget for the organ- 
ization of special classes for the care of children exposed to tu- 
berculosis in their homes. Nevertheless, if the fight against this 
disease is to be won, a beginning must be made with the chil- 
dren. Money is, therefore, well spent and also economically, 
in providing classes for open air treatment for pretuberculous 
children. 

I OPEN WINDOW CLASSES 

The beneficial results obtained through open air treatment of 
physically subnormal children have led to the application of this 
treatment as a prophylactic measure, for physically normal chil- 
dren. The stimulation of the lowered temperature, during the 
period of artificial heat, and the abundance of fresh air, have re- 
acted favorably for both physical and mental development. 



52 

LOCATION 

The open window classrooms for children having marked 
chronic organic diseases should be located not higher than one 
flight. This restriction need not apply to the location of open 
window classrooms for physically normal children and children 
discharged from open-air classes. 



STRUCTURE 

The open window classroom requires no structural changes. 
A schoolroom of the regular type is used, preferably a corner 
room, with a southeasterly or southwesterly exposure, so that 
direct sunlight may be had for practically the whole school day. 



VENTILATION AND TEMPERATURE 

The ventilation is direct, fresh air being admitted through 
open windows, equipped with glass window ventilators, to pre- 
vent drafts. Under the present method, these window ventila- 
tors are made of wooden frames covered with cloth. This cov- 
ering rapidly becomes soiled by dust and rain, and does not 
transmit light. For this reason, it is unhygienic and should be 
replaced with glass wind shields, or ventilators. 

Open windows, in winter, without such protection, expose 
children seated near them to drafts. 

The temperature in open window rooms should be maintained 
at a point between 50° F. and 60° F. by the use of artificial heat 
during the winter months. 



TYPE OF CASE OPEN WINDOW CLASSES 

Two special groups are included in this classification : 
L Physically subnormal children. 
II. Normal children attending regular classes. 



53 

The first division includes the following groups : 

1. Children discharged from fresh air classes. 

2. Those predisposed to respiratory diseases other than tuberculosis. 

3. Children who display possible cardiac symptoms such as doubtful 
murmurs, mainly functional. 

4. Those showing mild symptoms of chorea. 

5. Selected children showing symptoms of organic cardiac disease. 

6. Cardiac patients who require further school segregation and pro- 
phylactic care. 

7. Crippled children. 

(a) Nontuberculous, such as those resulting from poliomyelitis, 
scoliosis, spastic paralysis, congential malformations, amputa- 
tions, progressive muscular dystrophy, etc. 

(b) Tuberculous, such as those suffering from bone tuberculosis 
of all types. 

Special school care, prescribed in accordance with the medical 
treatment and recommendations of the attending specialists, is 
given to each of these special groups. 

The second group comprises physically normal children 
who have been placed in open window classes, with the permis- 
sion of their parents, in order to receive the benefits of fresh air 
treatment, in a large city throughout the school day. 

Eighty-six open window classrooms for physically normal 
children are now conducted in 22 public schools in three bor- 
oughs of the City of New York. 

SUMMARY AND RECOMMENDATIONS 

It is respectfully recommended that: 

1. The type of physical defect be the basis for the segrega- 
tion of groups of physically handicapped children in special 
types of classrooms, that is, outdoor, open air and open window 
classrooms. 

2. A thorough physical examination be given all children 
before assignment to such special classrooms. 



54 

3. Clinic or hospital record cards of each child, indicating 
the diagnosis and results of these physical examinations and rec- 
ommendations of the attending or examining physician, be the 
basis for segregation and subsequent school care in special 
classes. 

4. The range of temperature be governed by the type of 
physical defect of each special group. 

5. Glass wind and storm shields be used so as to admit light 
and regulate heat, replacing the canvas or wood protectors now 
in use; and that specially constructed window ventilators be in- 
stalled in all open window classrooms to prevent drafts and to 
protect children seated near open windows. 

6. No classroom for physically handicapped children be lo- 
cated higher than the second floor of a school building or annex, 
unless an elevator is available. 

7. In out-door, open air, and certain types of open window 
classrooms, movable adjustable desk-chairs be used instead of 
fixed furniture. 

8. A type of personal equipment be adopted which allows 
the greatest freedom possible for schoolroom activities and phy- 
sical exercise, eliminating the danger arising from' fire drills 
and other emergencies ; that it be easily cleaned so as to be sani- 
tary, since type of equipment commonly in use fulfils none of 
these requirements. 

Furthermore, a child, before placement in a special classroom 
with lowered temperature, be provided with appropriate under- 
wear and sufficient outer wraps, as well as a storm equipment, 
so that he suffers no ill effects of exposure when he leaves the 
classroom at the end of a school session. 

9. In connection with the anti-tuberculosis crusade associa- 
tions, and in accordance with the request of the Commissioner 
of Health, open air treatment be extended to all pretuberculous 
school children through the extension of fresh air classrooms in 
five boroughs. 



55 

PROPHYLACTIC TREATMENT OF PRE-TUBERCU- 
LOUS CHILDREN— STUYVES ANT TUBERCULOUS 

CLINIC 

Six years ago, when the Board of Health, through the Divis- 
ion of Preventable Diseases and the Ladies' Auxiliary of the 
Stuyvesant Tuberculosis Clinic, requested the Department of 
Education to provide a technically trained instructor to co-oper- 
ate in the prophylactic treatment of pretuberculous school chil- 
dren in that clinic, the experimental study and administration 
thereof, was referred to the Department of Physical Training. 

TYPE OF CASE 

The pretuberculous children attending the tuberculosis clinics 
of the Board of Health are either those of tuberculous parents 
and are, therefore, predisposed to tuberculosis, or come in daily 
contact with tuberculosis in their homes through some member 
of their family. They are, therefore, in greater danger of con- 
tracing tuberculosis than any other group of school children. 

Since tuberculosis is both a preventable and curable disease, 
the saving of these children from tuberculous infection has be- 
come one of the most important strategic movements in the cru- 
sade of the Anti-Tuberculosis Associations. 

Thus, through prophylactic care, can the spreading of this 
disease be prevented among school children, saving untold suf- 
fering, and furthermore, it is an economic measure. 

The prophylactic treatment established by the Department of 
Physical Training consists of a system of health building based 
upon open-air preventive and corrective exercises, supervision 
of diet, personal, home and school hygiene and the correction of 
the physical defects noted upon the clinic record cards of each 
child, through various physical and medical examinations. 

WORKING GROUP AND CONTROL GROUP 

From the hundreds of children associated with this clinic, 150 
were selected with the permission of their parents, for a technical 



56 

and comparative study of the results of this prophylactic treat- 
ment. 

Each child in this working group, and also each in the control 
group not under treatment, were given a thorough physical and 
medical examination, at the beginning of the experiment and at 
stated intervals thereafter, for the purpose of comparing the two 
groups and also each child's previous record within his own 
group. 

SUMMARY OF CLINIC RECORDS 

A Study of the comparative records and statistics of both 
working group and control group of pretuberculous children has 
demonstrated a typical physical condition, sufficiently alike, in 
such children to form a basis for work. 

In all cases, the depressed chest, prominent scapulse, the 
hollows above the clavicles and forward carriage of the head, 
are most marked. A characteristic defect is the excessive meas- 
ure of the prominent waist and abdomen, even in emaciated chil- 
dren. This has been found to be typical of children with a tu- 
berculosis diathesis, and in all cases had a distinct relation to a 
demineralized diet. 

To overcome these characteristic defects, special corrective 
exercises for clinic and home use were prescribed and taught to 
the children. These were adapted to the age of each group of 
children. 

DIET 

A summary of the records of the daily diet of these pretuber- 
culous children showed a widespread use of demineralized foods 
as white bread and crackers, polished rice, white cereals, white 
macaroni and the daily and excessive use of free sugar, besides 
raw butter and raw milk. Coffee was a daily beverage of 60 
per cent of the children, and 65 per cent drank tea and other 
stimulants. The average dietary contained a large percentage 
of acid-producing foods and very little base-forming foods. 
Such a diet is particularly pernicious for pretuberculous chil- 
dren, for gradually it produces an acidosis which even in its 



57 

mildest form is the most relentless destroyer of calcium in break- 
ing down the tissues of the body as a forerunner of tuberculosis. 

In order to obtain the best results from the physical care pro- 
vided for these children, it was found to be necessary to make 
radical changes in this diet. Through health talks, the children 
were taught the value of certain articles of food and the dangers 
of others. Varied and nutritious lunches have been provided, 
through the Ladies' Auxiliary, after each exercise period in the 
clinic, and a liking for wholesome, simple foods has been edu- 
cated on the part of the child. 

PHYSICAL DEFECTS 

The physical defects of the working group were carefully 
noted and remedied in order that each child might be placed in 
the most favorable condition to profit by the prophylactic treat- 
ment later. 

One hundred and fifteen cases of adenoids and diseased ton- 
sils were referred last year for treatment to the hospitals co-op- 
erating with the Stuyvesant Clinic, and 50 successful operations 
were performed for the removal of these growths. Children 
suffering from eye defects, discharging ears, tuberculous glands 
and other physical defects, were placed under treatment. 



DENTAL INSPECTION 

The summary of the records of defective teeth of these pre- 
tuberculous children shows astonishing results. One hundred 
per cent of defective teeth were on record, and in many in- 
stances every molar was lost through caries. This is a most 
serious condition, indeed, and points to the elimination of calcium 
(which is one of the defenses of the body against tuberculosis), 
far beyond the normal amount in these children — a gradual loss 
of immunity. 

Tooth brush drills were instituted as part of the routine of 
the hygienic inspection, and individual tooth brushes and paste 
were provided. 



58 

Finally, the Ladies' Auxiliary of the Stuyvesant Clinic, 
through Mrs. Charles Augustus Frank, the President, success- 
fully solved this problem by establishing a dental chair in this 
clinic for the treatment of the children. 

The record of this dental clinic is one of the best to be re- 
ported in this city. A record of 85 per cent of the children 
under treatment for whom all dental work has been completed, 
is an index of the splendid work which is being accomplished 
for them. 

The correction of this common physical defect, and the reac- 
tion of clean mouths, upon these physically handicapped children 
have proved of the utmost value in paving the way for their pro- 
phylactic treatment. Furthermore, the children are able to 
masticate their food better, and without pain, and this has en- 
couraged better appetites and assimilation of food. 

The clinic nurses make frequent visits to the homes of the 
children to instruct in home hygiene, preparation of a whole- 
some diet, and other important factors bearing upon health care. 
Through this co-operation the instruction given to the children 
at the clinic is followed in their homes. 



RATE OF INCIDENCE OF TUBERCULOSIS 

The rate of incidence of tuberculosis of all the children at- 
tending the Stuyvesant Tuberculosis Clinic in 1915, when the 
prophylactic treatment was first established, was four per 100. 
Since then, each year the rate has gradually decreased. 

Considering this as the basis, there should have been six 
cases in the group of 150 children under treatment in 1915-16, 
and four cases in the working group of 175 children in 1918, 
whereas there were no cases of pulmonary tuberculosis in the 
former group. This is, therefore, not a matter of chance. 

RESULTS 

This treatment was introduced at the Stuyvesant Clinic as a 
prophylactic measure to aid in reducing the number of cases of 



59 

pulmonary tuberculosis in the pretuberculous school children at- 
tending this clinic. 

A comparison of the records of the working groups with then- 
own previous records, and those of the control groups, show 
that a marked improvement in weight, height and other physical 
conditions is evident. Their posture shows a remarkable 
change with resulting improvement in chest expansion and ca- 
pacity. Better habits of breathing have been established, and 
an increased power of endurance and mental alertness. The 
records of both personal and home hygiene, including ventila- 
tion, hours for sleep, bathing and diet, show great improvement, 
also. 

These children have been practically free from colds during 
the winter, and, furthermore, there have been no cases of tuber- 
culosis in the working groups, while active cases of tuberculosis 
have been found in the control groups. 

PRETUBERCULOUS CHILDREN IN THE PUBLIC SCHOOLS 

From the records of the tuberculosis clinics, Dr. Copeland, 
Commissioner of Health, has reported that approximately 12,000 
pretuberculous school children attend the tuberculosis clinics of 
the Board of Health. Most of these are pupils in the public 
schools of the City of New York. 

This group should receive specialized physical training as a 
prophylactic measure, similar to that now conducted in the Stuy- 
vesant Tuberculosis Clinic by the Department of Physical Train- 
ing. These pretuberculous children should likewise be placed 
in fresh air classrooms, and all physical exercises should be con- 
ducted out doors. 

It is extremely important that all of these children be given 
an opportunity in school, by means of special accommodations, 
to overcome the baneful influence of their home environment, 
both for their own health care, and that of the physically normal 
children with whom they are associated. No condition of their 
school life should be contrary to the regulations prescribed 
through the tuberculosis clinics which they attend, in order that 
they may eventually become strong and useful citizens. 



60 



SUMMARY 

As the result of the experimental study with pretuberculous 
children of the Stuyvesant Clinic, permit me to respectfully rec- 
ommend that : 

1. This system of prophylactic treatment be extended, 
through the Department of Physical Training, to all the 
tuberculosis clinics of the Board of Health, in accord- 
ance with the request of the Commissioner of Health to 
the Board of Education, 

2. All pretuberculous children listed at tuberculosis clinics, 
and attending public schools, be placed in fresh air 
classes. 

3. The system of prophylactic treatment in use at the Stuy- 
vesant Clinic be extended to these children in fresh air 
classes, through the Department of Physical Training 
during school hours. 



61 



THE BLIND AND SIGHT CONSERVATION CLASSES 



FRANCES E. MOSCRIP, INSPECTOR 



DISTRIBUTION OF CLASSES 



The following table shows the distribution by schools and 
boroughs of the blind and sight conservation classes: 



Manhattan 



The Bronx 



Brooklyn 



Queens 



Blind Sight Con- 


B] 


lind 


Blind 


Sight Con- 


BHnd Sight Con- 


servation 








servation 


servation 


P.S.54 P.S.6(2) 


P. 


S.4S 


P.S. 


P. S. 47 


P.S. 77 P.S. 77 


P.S. 110 






127 (3) 


P. S. 75 




Wad- 








P. S. 83 




leigh P. S. 17 (2) 








P. S. 93 




High P. S. 21 






P.S. 


P. S. 147 G 




School 






157 






DeWitt P.S. 57 












Clinton P.S. 65 












High P. S. 84 












School P. S. 89 












P.S. 102 












P. S. 119 












P. S. 160 












P. S. 166 













In addition to the pupils in these classes, there are the names 
of 400 children on a waiting list, compiled from those who have 
been examined by the oculist and recommended for sight con- 
servation work. Owing to the difficulty experienced in secur- 
ing suitable rooms in the congested sections of the city, and to 
the lack of a necessary co-ordinating agent between the homes 
of the pupils and the school and clinic, provision for suitable 
education of these pupils has been delayed. If the testimony of 
the Judges of the Children's Courts is authentic, and the records 
of the Courts reliable, means should be taken at once to get pupils 
suffering from eye strain under proper supervision, thus pre- 
serving another group from delinquency and crime. The pupils 
already enrolled in the sight conservation classes testify to their 
value from many different angles. The services of a visiting 
teacher or regular teacher assigned at large would be an impor- 



62 

tant contributing factor to the work of organizing classes and 
influencing parents to take advantage of them for their partially 
sighted children, and in effecting conditions favorable for child 
development. 

EYE CLINICS 

Too much credit cannot be accorded the special eye clinic and 
general eye clinics conducted by the Department of Health under 
Dr. Beals for the splendid treatment given the pupils of the de- 
partment and the genuine interest shown in the educational ad- 
justments as well as the health problems. Many a helpful sug- 
gestion to teachers has originated in the clinic, particularly in 
the nature and extent of work permissible for the more serious 
and puzzling cases. More than one pupil has been persuaded in 
the clinic to make the change from the normal to the sight con- 
servation class. 

Upon more than one occasion, the Inspector has been advised 
and assisted by experts from the Department of Health relative 
to suitable lighting, size of print for textbooks, colors to be em- 
ployed in preparation of charts and books, types of furniture to 
be used, especially desks for physical comfort and alleviation of 
eye-strain. Parents and teachers are most generous in their 
praise of the methods employed in the treatment of the children. 

The results of treatment and refraction have been highly sat- 
isfactory. Many pupils under special instrrction have been re- 
turned to the regular grades with eyesight sufficiently improved 
to enable them to pursue their studies in the usual way. The 
following case will demonstrate the practical results which fol- 
low eye treatment : A deaf, blind girl who has been a difficult 
pupil in one of our classes for a number of years has, as a result 
of electrical treatment in the clinic for more than a year, recov- 
ered sufficient vision to enable her to secure a position recently 
as a domestic helper in a good home at $12 per week. Her em- 
ployer is entirely satisfied with her service. The girl is allowed 
ample time for recreation and rest. Through this position she 
has been saved from a life of misery in some of its manifesta- 
tions. To carry on the good work begun in the clinic, a visiting 
teacher ought to be employed. 



63 



PRODUCTION OF TEXT BOOKS 

The work of embossing and printing in the Braille print shop 
has maintained its standards of excellence and output. During 
the last three years the following textbooks have been prepared 
for our blind students : 

Chardenal's French Grammar 

Lamb's Tales from Shakespeare 

The World War Syllabus of the Board of Educa- 
tion 

Pecheur dTslande 

Contes et Legendes, Books I and II 

Alternate Exercises for Introductory French Prose 
Composition 

Les Oberle' 

Ashley's American History 

Ely & Wickler's Principles of Economics 

Colomba 

Rexford's Articles on Community Civics 

In addition to these, selections, notes, spelling-lists and dia- 
grams have been put into Braille. Through the introduction of 
Braille contractions and word-signs, a saving of 40 per cent has 
been efifected on the cost of materials and labor. The shortened 
forms are used for all books from the fifth year elementary 
school through high school. A problem' of equal importance 
with the production of Braille reading matter has been the prep- 
aration of books and pamphlets in enlarged print and script for 
the partly sighted pupils. To Cleveland belongs the honor of 
the only plant operated exclusively for printing textbooks in en- 
larged type. Some of the output of this plant has been pur- 
chased by the Board of Education for our sight conservation 
classes. These books are expensive and their scope is limited. 
It has, therefore, been necessary for the special teachers t.6'':i5re;: 
pare much of the large type material required by the partly- 
sighted pupils. They have untiringly thrown their efforts irito^ 
the enlargement of text, arduous and endless on account of our 
co-operative plan of instruction with the regular grades. These 



64 

endeavors are more than repaid by the spirit of pride, competi- 
tion and team work developed by contact with the normal child 
in recitation, and by the normal standards of life acquired by 
the handicapped pupils. In the near future it is hoped that 
pamphlets for sight conservation use may be prepared in the 
Bureau of Vocational Activities. 



AFTER-SCHOOL RECORDS 

The majority of the blind and sight conservation pupils who 
have left school are engaged in lucrative employment which 
covers a variety of occupations. In ofifice work we have a typist, 
two switch-board attendants and a dictaphone operator. Two 
totally blind young men are making good in insurance work. 
Several are engaged in canvassing for books, magazines, toilet 
articles and so forth. Our pupils are also well represented in 
light forms of factory work, such as wrapping and packing 
candies, twisting wires for hair-curlers, assembling small parts 
for machine construction and filling cartons. Two partly sighted 
young people are operating elevators, and one is engaged in a 
beauty parlor. One blind young man buys and sells pianos. 
These young people have a salary range from $8 to $22 weekly. 
Two blind Wadleigh graduates are at college — one at Cornell 
and the other at Hunter. A DeWitt-Clinton boy is at Columbia. 
Gratifying reports of their progress are received from time to 
time. 

MANUAL WORK 

Instruction in basketry, brush-making, chair-caning, weaving 
and cooking has been given to both blind and sight conservation 
pupils of the upper grades. The bhnd have also taken up sew- 
ing and shop work. In one sight conservation class a dozen 
chairs in use throughout the school were reseated with care. 
In two centers, one blind and the other sight conservation, 
brushes of various kinds are made and sold by the pupils. The 
money is used to purchase raw njiaterials to continue the activity. 
Many of the sight conservation pupils have shown skill in the 
making of toys. 



65 



WAR ACTIVITIES 



The special classes of this department have engaged in every 
war activity pursued in the schools, with highly satisfactory 
results. A blind girl in Public School No. 110, Manhattan, sold 
$22,000 worth of bonds, the highest record in the school. The 
class for the blind in Public School No. 17, Manhattan, held first 
place in the school of 51 classes in the Thrift Stamp Contest for 
one week, and never fell below third place during a whole term. 
Sweaters, socks, helmets, wristlets, pillows, etc., were made for 
the Red Cross in large numbers. Mrs. Dean, Mrs. Jessup and 
Mr. O'Shea expressed their appreciation of the quality of the 
articles turned in by the blind, pupils. Many of the blind and 
sight conservation classes boast 100 per cent membership in the 
Red Cross, many Victory boys and girls, bond-holders and bond 
salesmen, and even two-minute orators. 



FUNCTION OF THE SIGHT CONSERVATION CLASS 

This seems a good opportunity to make the function of the 
sight conservation class better understood. In the first place it 
affords educational opportunity to the child with impaired vision, 
and turns him out of school an asset to the community instead 
of a burden and possibly a menace. Secondly, by working with 
the Department of Health eye clinics, it makes treatment, fre- 
quent and necessary refractions, and medical supervision possible 
and effective. In the next instance it relieves the regular classes 
of a group of children who are, to put it mildly, laggards and 
drawbacks to regular instruction and confirmed repeaters. Still 
further, the methods employed by the sight conservation classes, 
particularly in the lighting facilities, health conservation, and 
positive processes of development, could well serve as an ex- 
ample to the pupils of the regular grades and to the people in the 
homes of the pupils. The following extracts from the reports 
of sight conservation teachers will be helpful to a better under- 
standing of this new work: 

"The children who were uneasy and indifferent upon their entrance 
to the class have acquired a poise and restfujriess which I attribute to 
the relief from eye strain," 



66 

An Italian boy : "A truant, also a C pupil, now attends regularly 
and is A in conduct and efifort." 

An Irish lad : "While a pupil of a normal class he was two terms in 
a grade. After entering my class he was twice recommended for pro- 
motion in mid-term. The first time the doctor advised against it 
because of his general condition, but the second time he was promoted 
and did the work of two grades in one term with a splendid record." 

A Jewish girl : "She could see only the second line on the Snellen 
Chart when she first went to Dr. Beals. Now she can read the sixth 
line." 

Girl transferred to normal class after two years : "Eyes now normal 
with glasses. Work in regular school good." 

RECOMMENDATIONS 

With the appallingly large percentage of eye defects in the 
rejections from the army draft confronting us, and the impetus 
given the work for the blind by the treatment and training pro- 
vided for the military blinded, particularly by the British Gov- 
ernment under Sir Arthur Pearson's leadership, we can well 
afford to increase our facilities for the instruction of blind and 
partly sighted pupils and give them adequate training daring 
their plastic years. Accordingly I am recommending for the 
coming year : 

1. An improved equipment of classrooms now in use and 
the inclusion of suitable rooms for blind and sight con- 
servation classes in the plans for new school buildings. 
Plans for artificial lighting on dark days otight to be 

^ effected immediately under the direction of lighting ex- 
perts, and approved by the oculist in charge of the de- 
partmental work. 

2. A visiting teacher to study home conditions and to bet- 
ter co-ordinate the work of the school and clinic. 

3. A music teacher for the blind classes. Reasons for this 
are apparent and urgent. 

4. FaciHties within the Board of Education for printing in 
greatly enlarged type. The vocational schools would 
probably be a solution of this problem. 

5. Ample budgetary provision made for suggested changes 
and accommodations for an ever-increasing enrollment. 



67 




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68 

PHYSICAL TRAINING FOR THE BLIND 

Adela J. Smith^ Assistant Director of Physical Training 

SPECIALIZED PHYSICAL TRAINING 

When the special classes for the blind were organized, the 
supervision of the physical training- and hygiene was assigned to 
the Department of Physical Training. This special attention to 
the physical welfare of these handicapped children, has proved 
to be an extremely important factor in the education of the blind 
in public schools. Aside from the physical benefits of health, 
strength and endurance, the association of the blind with normal 
children in their games, dances and other physical activities, has 
had a psychological effort of the utmost value in their normal 
mental development. 

Through a new system of specialized physical training, based 
upon their physical handicap, the blind children are first taught 
as a segregated group through special methods and devices, to re- 
spond to directions for physical activities. Each child is en- 
couraged to do this through his own interpretation and defects of 
posture, position or direction are corrected by the teacher only 
after independent effort on the part of each child. 

It is necessary first to break up old habits and encourage the 
blind child to re-act normally to his surroundings. The slow, 
groping, shuffling walk of the blind must be overcome and 
changed to an alert, light lively step with good posture. Event- 
ually he must also be taught to run and skip. Other character- 
istic idiosyncrasies must be corrected also. 

Many devices have been invented, and special methods of 
instruction used for obtaining this motor response. For in- 
stance, rope guides are used as a device in teaching the blind to 
improve their speed of locomotion and length of step. These 
ropes are stretched tightly around the exercise space at a height 
of three feet above the floor and several feet from the walls to 
avoid contact. Bells are attached to the rope at the corners of 
the roped space, to indicate the places for turning while walking. 
The blind children are first taught to walk, then march, run and 
skip in this enclosed space beside the rope for a guide. 



69 




70 




HH '^ 



71 

At first, the children walk around the space encouraged 
through constant grasp of the guide rope with the hand ex- 
tended from the side. Then the normal walking step is taught, 
still with the children grasping the rope while walking. Later 
this exercise is taken in the normal walking position with the 
hands at the sides, and contact is maintained by touching the 
guide rope with the side of the arm. Finally, the children gain 
sufficient confidence to walk in a brisk, alert manner, and the 
guide rope is touched only occasionally and eventually not at all. 
The children are then ready tO' attempt marching to music, and 
even running and skipping. 

Contest running and roller skating are taught through this 
same method, but guide handles are used to protect the hands 
from the friction of the rope as it passes through the hand rap- 
idly. 

Courage, confidence and skillful body control is taught 
through the use of apparatus, such as the athletic slide, flying 
rings and pull up bar. 

Similarly, special training through other devices is given in 
each group of physical activities, and the blind children are 
gradually lead away from the segregated group through their 
proficiency in the physical activities of normal children. They 
are taught to improve their posture and their walk, to respond 
with alertness and accuracy, and tO' inhibit and control their 
movements. Through this special training, they have gained 
in endurance and become intelligent about the rules of games, 
athletics, and folk dancing. 

SIGHT CONSERVATION CLASSES 

Children handicapped by greatly impaired, defective or par- 
tial vision are assigned to these classes. They are physically 
able to take part in most of the physical training of physically 
normal children, but require in addition, special attention for 
certain characteristic physical defects. 

The impaired eyesight of this group has caused marked 
physical deterioration. Poor posture is characteristic, and this 
has resulted in depressed chests, prominent scapulae with marked 
impairment of lung capacity and strength. 



72 




7Z 

In most instances, this is a long standing condition induced 
by the children trying to force their impaired vision to do the 
work in regular classes. 

It is extremely difficult to overcome these physical defects 
by means of exercises with normal children. Besides this form 
of physical training, therefore, special exercises must be pre- 
scribed for both classroom and home use, in order to improve the 
physical condition of these children. 

HYGIENE SUGGESTIONS 

Several of the rooms now used by classes for the blind and 
sight conservation classes are not suitable for classrooms. Th;se 
rooms were not designed originally for such use, and are, there- 
fore, poorly lighted, badly ventilated, and in very cold weather, 
insufficiently heated. 

The quality of the air in a classroom is dependent upon an 
abundance of sunlight. One of the essentials in the care of 
physically handicapped children is a large, sunny, well ventilated 
classroom, especially since most of these children are physically 
impaired as a result of serious illiiess, and have therefore fee'jle 
constitutions. 

Furthermore, it must be considered that these children have 
the same classroom throughout their school life, while normal 
children change theirs each term. For this reason, it is impor- 
tant to consider the location and type of classroom. 

CLASSROOM EQUIPMENT 

Owing to their inferior physical condition resulting from 
their handicap, blind children suffer more from improper seating 
and other adverse school conditions than normal children. 
Furthermore, in each classroom there are children of various 
ages. The furniture, therefore, should have not only a w'de 
range of adjustment, but should be also of various sizes. Both 
desks and seats should be adjustable horizontally and vertically 
and should have a central support instead of two side supports 
to reduce the danger of tripping the blind child during his use 



74 

of the classroom. This would add much to the health and 
comfort of these handicapped children. 

A sanitary iron cot, with a canvas stretcher pillow and 
blanket, should be included in the classroom equipment, so that 
tired or sick children may rest. Sheets and pillow slips should 
be provided also, to keep the cots in a sanitary condition. 

I would, therefore, respectfully recommend that the class- 
rooms for the blind and the sight conservation classes may be 
equipped with three sizes of adjustable desks and seats, with 
central supports, a cot and supplies for its use. 

SUMMARY 

To aid in the health care of the blind cliildren in the public 
schools, it is respectfully recommended that : 

1. Large, sunny, well ventilated classrooms be provided 
for all classes for the blind and for sight conservation 
classes. 

2. That a complete classroom equipment may be provided 
including three sizes of adjustable desks and seats, cot 
and supplies for its use. 



75 



SIGHT CONSERVATION WORK IN THE PUBLIC 
SCHOOLS 

M. B. Beals, M. D., Supervising Oculist, Bureau of Child Hygiene, 
Department of Health, City of New York. 

THE WORK 

The sight conservation work in the public schools is to pro- 
vide conditions under which the partially sighted children may 
study without injury to the eyes, and to provide supervision and 
treatment by an oculist of the Bureau of Child Hygiene. 

The equipment for these classes consists of special large 
print, proper light, raised maps, adjustable desks and individual 
assistance by the teacher, who prepares all the work in a large, 
easily read copy, which permits the partly sighted child to keep 
pace with its normal grade without further loss of vision. 

Constant supervision and treatment is given by the oculist of 
the Bureau of Child Hygiene, Department of Health, who ex- 
amines the eyes of all candidates and assigns the child to a blind, 
sight conservation or normal class. He makes a full diagnosis 
and prognosis, and outlines the kind and quantity of work that 
may be permitted for each individual child. He also strives to 
improve the conditions found by the indicated treatment, be it 
disease or refractive error. 

Each child suffering from any eye disease or refractive error 
is instructed to go to his private oculist for treatment if financi- 
ally able, but in the great majority of children in these classes 
this is not the case, in which event, if the parents consent, the 
child is treated at the Child Hygiene Special Clinics for these 
classes. 

The oculist care of these classes have been under the Bureau 
of Child Hygiene, Department of Health, for about two years, 
with most gratifying results in a large number of cases, greatly 
assisted by the hearty co-operation of the Inspector of the blind 
and sight conservation classes, and her splendid corps of 
teachers. 



7(^ 

Some highly practical results have been obtained since the 
Bureau of Child Hygiene took over this work, results that would 
not have been obtained if the Board of Health had not taken this 
work over. 

We now have 699 active cases under our medical supervision, 
but not all placed in sight conservation classes as yet, due to the 
widely scattered locations of these classes, the result of trying to 
cover all of greater New York with but 30 classes. 

One thousand one hundred and fourteen cases with vision of 
20/50 or worse have been sent to the special clinic for sight con- 
servation cases as candidates for sight conservation classes, of 
which 639 have been terminated cured and 475, while still under 
treatment, have improved to such a degree that they have been 
assigned to normal classes. 

Of those cases in the sight conservation classes, Z}» have been 
terminated cured, and 34, though still under treatment, have so 
improved that they have been reassigned to normal classes. 

There are at present 99 children in the Ijlind classes. 

These children had nearly all been through the usual routine 
of medical school inspection, but due to defects somewhere in 
the system, either in the original vision test, follow up work, or 
lack of co-operation by principals and teachers, due in most 
cases to a lack of thorough understanding of the importance of 
this work, there had been failure to get them under proper treat- 
ment. 



CANDIDATES FOR SIGHT CONSERVATION CLASSES 

All children with a vision in the better type of 20/50 or worse 
are candidates for sight conservation classes. If the oculist 
cannot improve this vision the child may be assigned to the sight 
conservation class. \i the vision is improved to better than 
20/50 by glasses or treatment, the oculist will decide if sight 
conservation work would be beneficial. In many cases of pro- 



77 

gressive myopia the vision can be improved with glasses to a 
greater degree than 20/50 or even normal vision, 20/20, and yet 
the sight conservation methods of school instruction is very 
beneficial. 

A final recommendation should be obtained from the oculist 
in charge of the cases as to the use of eyes to be permitted in 
each case, with full instructions as to glasses and revisits to 
oculist, as by this method only can most children be kept under 
most favorable conditions. 

By far the most common cause of loss of vision of the chil- 
dren of the sight conservation classes is progressive myopia. 



PROGRESSIVE MYOPIA 

Progressive myopia is a subject that the general practitioner 
and the school teacher should be far more familiar with than 
.many now are. They should be sufficiently familiar with this 
subject to be able to explain intelUgently to parents and children 
why the myopic eye needs so much more careful and constant 
attention than other forms of refractive errors. 

Myopia or near sight is a misleading name. It should be 
poor far sight. The vision is simply nearly normal at the near 
point and very poor or not at all at the distance. The principal 
cause of myopia, and practically the only one that the non-spe- 
cialist need consider, is the bulging of the posterior or back wall 
of the eyeball, which causes the retina or receiving structure of 
the eye, lining the inner surface of the wall of the eyeball, to be 
moved back beyond the point of focus of parallel rays of light 
passing through the lens of the eye at the aperture called the 
pupil when the lens is at rest. To produce a focus of these 
parallel or distance rays of light on the retina, which is necessary 
for vision, the lens must be changed in shape by the constant 
action of small muscle fibers within the eye called the ciliary 
muscles. 

Nearly every one is famihar with the change in the shape of 
the bones of the face, nose and mouth by the steady pressure 



78 

produced by mouth breathing in cases of adenoids in children. 
If this is possible with the bony structures, how much more easy 
is it to appreciate how the soft structure of the eye can be 
changed in shape by the constant pressure such as exists in the 
myopia eye from this constant action of these muscles in the 
near sighted eye of the growing child. 

THE LENS OF THE EVE 

The lens of the eye is a gelatinous strrcture contained in a 
capsule, and its curve and thickness is changed by the action of 
these muscles to bring the rays of light from varying distances 
to a focus on the retina. In myopia it is necessary to flatten the 
lens to reduce its curve to produce this focus, and to do this, 
these muscle fibers are constantly pulling from the edge of the 
lens to the side wall of the eye, producing a constant drag on 
these walls, which is the source of a great deal of injury to the 
eyes, principally the increase in the bulging of the back of the 
eye, due to stretching of the weakened wall of the eye, but also 
other injury as a varying amount of separation of the retina 
from the optic nerve, detachment of the retina from the wall 
of the eyeball and hemorrhage in the retina. 

We can now see why myopia is progressive and why myopia 
of any marked degrees is called progressive myopia. A great 
amount of this injury can be prevented by proper treatment and 
control if this treatment and control is started early in child life 
and continued and maintained d'ring that period when the tis- 
sues are developing. 

It is here that the sight conservation class is of inestimable 
value in co-operating with the oculist in saving these near sighted 
children from this irreparable injury to their vision. 

The constant strain of the near sighted eye can be relieved 
by wearing glasses if the glasses are properly fitted, combined 
with the proper use of the eyes, but it is only by the co-operation 



79 

of the family ph3^sician, teachers, social workers and school 
nurses that the parents and children can be educated up to the 
point of giving these eyes the proper and sufficiently sustained 
care. 

It should be clearly explained to parents that every myopic 
or near sighted eye has developed a chronic contraction of those 
small muscles within the eye. This is called a spasm of the 
ciliary muscles. This is why it is necessary to use a mydriatic, 
popularly known as "drops," in the eyes to relieve the chronic 
contraction or spasm of this muscle to allow the lens of the eye 
to resume its natural curve at rest, so that the glasses may be 
fitted properly for the lens in its real curve, and not to the altered 
curve produced by the spasm. 



NEED OF GLASSES 

This will also emphasize the necessity of having the near 
sighted child fitted with glasses by the experienced oculist and 
not by an optician. The optician is not permitted to use "drops" 
by law, because he is not qualified to do so, and no near sighted 
eye in childhood can be fitted accurately without these drops, and 
also explain that the proper fitting of glasses to near sighted 
eyes calls for the highest skill of the experienced oculist, which, 
of course, is not possessed by the optician. 

The progressive nature of this condition is the reason that 
these eyes should be refitted under drops with glasses at least 
once a year, as it is important to prevent all strain on the yield- 
ing wall of the eyeball that would be caused by even a small 
change in the eye. After the proper glasses are procured, they 
must be worn at all times for the same reason. 

Those having control of children of school age should know 
the importance of proper light and the harm done by working 
the growing eye in improper light. The starting of near sight 
in a normal eye is undoubtedly very often caused by the eye 
strain necessary to read and study in a poor light. 



80 

The question of light receives but scant consideration in our 
schools. I have seen many classrooms lighted very badly by gas 
on all days but the very brightest. 

No more favorable setting could well be imagined for the de- 
velopment of myopia, elepherities, headaches and all that long 
list of neuroses caused by eye strain in the growing child. 



NEED OF PROPAGANDA 

It is necessary to do a great deal of educational and propa- 
ganda work with the authorities in the Department of Education 
before we shall be able to correct these defects in our schools and 
guard against repetitions in new buildings. Many of our schools 
used for night schools are not provided with proper lighting 
equipment, and the work done in these schools by the pupils un- 
der this poor illuminating is producing the same bad results as 
in the poorly lighted day schools. 



REFRACTION 

A large part of the good results of the work of sight conser- 
vation clinic is obtained by skillful refraction, which is the fitting 
of glasses. 

Refraction of the partly sighted child, the mentally defective, 
backward or very young child, requires the highest skill of the 
experienced oculist, and is wholly beyond the skill of the oculist 
of little experience or the optician. 

This work calls for the constant use of Skiascopy or the 
Shadow Test, by which the measurement of the refraction of the 
eye is made without any assistance from the child as in these 
classes of children, the child can be of but very doubtful assist- 
ance to the oculist. After years of practice, a high degree of 
accuracy is obtained by this method of refraction. 

A great deal of harm may be done to defective eyes by their 
use, and harm may be done to the physical well being of the child 
from eye strain producing reflex nervous symptoms. 



81 



UNGRADED CHILDREN 



Out of 132 ungraded or mentally defective children whom I 
refracted, and for whom the glasses were procured, 24 were 
found to be nomial mentally after relieving their eye strain, and 
giving them vision, and more than 65 per cent showed decided 
mental improvement and many showing physical improvement. 
One little girl, for example, nine years of age, always in an un- 
graded class, had never been able to read or write and of such a 
vicious temper that constant care was necessary to prevent her 
from injuring other children of her class. She also> suffered 
from severe nervous symptoms of a choreic nature. Within two 
months after I refracted her and she began wearing glasses, a 
most remarkable change occurred. She made rapid progress in 
reading and writing and all other branches of work done by this 
class, but the most striking change occurred in her nervous sys- 
tem. From a vicious, dangerous child she changed to a happy, 
lovable little girl, and her pronounced symptoms disappeared. 
In about six months this child lost her glasses, and was without 
glasses for about two months. During this period the child re- 
lapsed completely. Again she would not or could not read or 
write. It was impossible to get any mental concentration. She 
became again vicious and all neurotic symptoms returned. At 
last the glasses were again procured, and the picture again re- 
versed itself in its entirety as on the first occasion, furnishing 
one of the most striking examples of the profound effect of eye 
strain on both the mental and physical development. 

HANDICAP TO NORMAL CHILDREN 

On the child of normal mentality, defective vision is a great 
handicap as is shown in every large school or group of schools. 
In a group of 400 habitual left back children found in a large 
New York school, I found more than 100 had decided refractive 
errors, and I prescribed glasses for about 110—100 of these chil- 
dren procured these glasses, and in less than three months some 



82 

very pleasing results were obtained. Out of 100, more than 90 of 
these left backs passed the regular school examination, many 
skipping classes, and one boy, far behind his grade for age, 
skipped five grades on this examination. Of the 10 who did 
not have their prescription filled for the glasses which I had pre- 
scribed, only one was promoted. In the same school we had the 
walls of a small room nearly covered with test papers, showing 
the startling improvement ma-de in writing, drawing and arithme- 
tic in remarkably short periods, of children of all ages, after 
correction of refractive errors. 



RESULTS 

I wish to report some very pleasing and unusual results ob- 
tained in the treatment of corneal opacities by the negative gal- 
vanic electricity. 

Those of the medical profession who are not specializing in 
eye work may not be familiar with these conditions or know how 
difficult it is to produce any appreciable results from any treat- 
ment of these old cases which have passed beyond the acute stage. 
Especially is this true in the general eye clinics, where, in the 
great majority of cases, nothing is even attempted. 

At our child hygiene eye clinic at Public School No. 30, Man- 
hattan, about one year ago we installed a small wall cabinet for 
the purpose of administering negative galvanism to these very 
unfortunate cases, and have produced decided improvement in 
vision in a number of cases. The treatment is necessarily a slow 
and long continued procedure, but in many cases surprising im- 
provement in vision will be obtained if the treatment is persist- 
ently given for 10 to 12 months, once or twice a week. 

The following are results in treatment of school children in 
the sight conservation classes: We have 27 cases under treatment. 
Case 1. A girl with old corneal opacities of both eyes and a 
vision of 20/70 in both eyes, with glasses, had improved after 31 



83 

treatments so much that her vision is now 20/20 in both eyes 
with glasses. 

Case 2. A boy with corneal opacities in both eyes, with a 
vision of O. U. 20/200, and no improvement from glasses, had 
had but 12 treatments, and his vision has improved to O. U. 23/40. 

Case 3. A boy had a vision of 20/100 caused by corneal 
opacities, had received Z7 treatments and now has a vision of 
20/40 and has been promoted twice. 

Case 4. A boy had a vision of 4/200, due to very dense 
corneal opacities. After 10 treatments his vision has improved 
to 20/200. 

Another activity has been the treatment of tuberculo kera- 
titis with tuberculines and vaccines furnished by the Department 
of Health. This is being done at eye clinics of the Bureau of 
Child Hygiene in Public School No. 21 and Public School No. 
65 — 38 school children have been treated. All have been im- 
proved, some most markedly. All cases presenting themselves 
were first given the Von Pirquet Test, and only those were 
treated who responded to this test. 



WHITMAN S VIEWS 

Lloyd B. Whitman's articles of September, 1915, in "Archives 
of Ophthalmology," takes not only the sordid view of this subject 
which I express, but also the higher appreciation of its impor- 
tance as follows : "Economically, the conservation of vision can 
be rated almost as high as the conservation of life, from some 
standpoints higher, for, when dead, as man imposes no burden 
upon the public. Not so with the blind, who must be housed, 
clothed and fed. As they are not producers, we must add what 
they would have contributed toward the national wealth had they 
been able to work. Another source of loss is in the public 
schools. To children with faulty eyes, school work is a pain 



84 

and a burden. They are always behind their classes, an exasper- 
ation to their teachers, a discouragement to themselves. Unless 
relieved and rendered fit for study, they are regarded as mentally 
deficient and become disheartened. Then, at the age of 14, they 
are apt to be taken from school and put to work, for which they 
are unequipped, and the State again loses ; loses money, loses a 
valuable worker or thinker, loses a useful citizen, and perhaps 
gains a rogue to support, because of the neglect of an examina- 
tion of the eyes and proper treatment." 



85 



SCHOOL FOR THE DEAF, P. S. 47, MANHATTAN. 
Carrie W. Kearns^ Principal 

I have the honor to submit the following report of the work 
done in the School for the Deaf for the years 1918-1919-1920. 

The many disturbing influences which entered into our work 
during this time made it difficult to realize all that we had planned 
to do. The influenza, the great amount of absence among the 
teachers, the lack of substitutes, and the frequent holidays, all 
tended to disturb our routine. However, we believe that the 
school has steadily improved, and that the close of this year shows 
better results than we have ever had. 

GROWTH OF THE SCHOOL 

Our register is 300. In comparison with other schools for 
the deaf throughout the country, this is a good number. The 
largest institution in the country has an enrollment of a little 
more than 600. It is a State institution. We graduate about 
15 children each year and a number of other older children go to 
work, but our numbers show no net loss. The greatest gain is 
in our kindergarten and first year classes, and this is the right 
place for growth. 

THE SEMI-DEAF 

I believe there are still a number of children in our regular 
schools who are losing their promotions and are being considered 
dullards, but who really fail to hear half of what is said in the 
classroom. These children are not conscious that they do not 
hear everything. They are shy and quiet. Their parents are 
loath to admit they are hard of hearing, and their teachers do 
not recognize that this is the trouble. 

In one case, this year, we had one little girl here almost a 
year before the mother admitted that she had another older child 
who did not hear much, and this admission came only after the 
principal of the school which the child was attending sent word 
to us about her. 

Many parents seem to think there is some disgrace attending 
deafness. They will not send the child to a school for the deaf. 



86 

Principals often listen to these parents, and from mistaken kind- 
ness allow the child to remain in the school, to drag along with 
this big handicap. The consequence is that the child is constantly 
at a tension. He is trying to hear all day, and he becomes nerv- 
ous and irritable. He never has more than "b" on his report 
card, and he often fails to be promoted. The probabilities are 
that he will never be graduated. 

OBJECTIONS RAISED TO ATTENDANCE AT PUBLIC SCHOOL NO. 47 

What are the objections to coming here? 

1. It is a school apart, with a dreadful name— the School 
for the Deaf — 

2. The child has some hearing, so he may hear the harsh 
voice of the congenital child. 

3. He may see some child using "signs.'' 

4. He will have to travel so far to school, and the carfare 
is too great an expense. 

ANSWER TO THESE OBJECTIONS 

1. It is a school for the deaf. We do not feel aversion 
to wearing glasses nor to the use of a crutch. Why 
should we try to hide deafness ? Deafness is a big handi- 
cap, but, if it is there, why not meet the situation and be 
glad that there is a school for such children? 

2. He will perhaps hear the voices of children who 
speak badly. However, the voices of the children are 
better than they used to be, and so far as possible, we put 
the children who have some hearing in classes by them- 
selves. This is always done in speech work. We 
hope to plan for this in our new building. 

3. As we are a public school, we must accept all children 
who apply for admission, unless they are mentally de- 
fective. Some of these come from schools where they 
have been allowed to use signs. Naturally they will 
continue to use them until they realize that the sentiment 
of the school is entirely against it. These "signers" 



87 

are few in number, and the child with partial hearing 
need not bother with them. 
4. After several years of trying separate classes in other 
boroughs, I find that deaf children need most careful 
grading, because of their big handicap of lack of lan- 
guage. Separate classes admit of very little grading. 
Children varying in ages get into one class. It is im- 
possible to do justice to all of them. This year all the 
children have been taught in the central school. We 
now have no scattered classes. The gain for the chil- 
dren has been marked. The children travel safely; 
they learn to' be independent and self-reliant — two very 
useful lessons. There is also a responsibility for the 
parent here. If a parent has a deaf child, it is the duty 
of the parent to make some home arrangements that the 
child may attend school with the least hardship. Free 
transportation is provided for all who cannot afford to 
pay carfare. 

ADVANTAGES OBTAINED BY ATTENDANCE AT THIS SCHOOL 

Now, as to the gain in sending a child here : 

In the first place, every child who comes here is carefully 
examined by our aurist and tested by the principal and teacher 
to determine the amount of deafness, etc. Sometimes, in order 
to be perfectly sure, a child remains with us a week, joins in the 
work of the class, sometimes of several classes, in order to test 
his hearing. He is never admitted if he shozus he has enough 
hearing to remain in a regular school. He is sent back with a 
note, telling the results of the test, and offering any recommenda- 
tions that may be deemed necessary. If any medical treatment 
can help him, the parent is advised what to do. But in many in- 
stances the child has not so much hearing as the parent thinks, 
and the deafness is progressive. It is better for that child to 
enter this school. If he is old enough to understand, he is told 
of his handicap, and of how he can overcome it by learning to read 
the lips and by being in a small class. 

Our classes have registers of 10 and 12. Here there is time 
for the teacher to repeat and explain several times. Everything 



is done to encourage the child. What is the result ? The child 
finds his balance, his nervousness disappears, he realizes that he 
can be an "A" pupil, he stays to be graduated, and he goes out 
from the school with confidence in himself. We have 60 such 
children in the school now. 

For the sake of such children, it would seem wise to call the 
attention of the principals to the need of examining all dull chil- 
dren to ascertain the amount of hearing they have. A child 
should not be allowed to grow dull because he does not hear. 
This should also be brought to the attention of the parents at 
Parents" Meetings. Misplaced sympathy should not interfere 
with the child's best interests. In the case of children too poor 
to pay for transportation, the city pays the carfare. 

STATISTICS 

The following statistics give an idea of the make-up of the 
school: Number of children on register, April 25, 1920. . . .290 

AMOUNT OF DEAFNESS. 

Totally deaf 152 

Can distinguish sounds 110 

Can hear words at close range 28 

AGE AT WHICH CHILDREN BECOME DEAF. 

Number born deaf 132 

Number deaf before 3 years of age 11 

Number deaf before 6 years of age 39 

Number deaf after 6 years of age 36 

Number who gradually become deaf 6 

CAUSES OF DEAFNESS. 

Congenital 132 Brain fever 2 

Spinal Meningitis 45 Diphtheria 5 

Scarlet fever 20 Convulsions 4 

Measles 11 Whooping-cough 4 

Abscesses 10 Mastoid 2 

Catarrh 19 Typhoid fever 

Colds 7 Marasmus 

Influenza 1 Rheumatism 

Fright 4 Tubercular 

Pneumonia 4 Kicked by horse 

Infantile Paralysis 3 Run over by auto 

Falls 4 Unknown 7 



89 

NATIONALITIES IN THE SCHOOL 

The following nationalities are represented in the school : 
English, Irish, Scotch, Swedish, Norwegian, Danish, German, 
Austrian, Hungarian, Bohemian, Russian, Polish, Galician, Rou- 
manian, Armenian, Italian and French. We have one child 
whose parents came from the West Indies, and two whose par- 
ents came from Malta. They are brother and sister. All the 
children in this school are loyal Americans. They have done 
their bit. In the Third Liberty Loan, they sold $17,500 worth 
of bonds ; in the Fourth they sold $40,000 worth ; and in the Fifth 
they sold more than the equivalent of a bond for every child in 
the school, which amounted to $43,900 worth. They adopted a 
French child, and are still paying for her support. They asked 
for a deaf child, and little Marie, a deaf child, was given them 
for adoption. They have her picture. During the years 1918- 
1919, they made and sent abroad the following: 

Babies' and children's garments ; 316 

Bags for hospitals 224 

Pillows and pillow cases 30 each 

Quilts 18 

Dolls, made and dressed 39 

Forty-three children pledged as Victory Boys and Girls, and 
every other pupil became a Victory Junior. In the Fifth Vic- 
tory Loan, they sold 298 bonds, which is equivalent to a bond for 
every child on register. 

In 1919-1920 they contributed $46 for the Near East Relief. 
Teachers and pupils gave $86 for the children and teachers of 
the School for the Deaf in Budapest. They are also giving 
their birthday money for the Serbians. 

CLASS ROOM WORK 

The great number of little children who have come into our 
kindergarten and first year classes is very encouraging. The 
earlier we can start them to speak and to read the lips and to 
grasp words and ideas, the better. It is a matter of congratu- 
lation that the work in this part of the school is now in excellent 
shape, so that from the kindergarten through the third year, the 



90 

progress is steady and gratifying. This is due to the fine plan- 
ning of my assistant, Miss D. F. Kaufifman, and to the committee 
of teachers who worked out a language story for each week of 
the term, this story embodying a language principle which is 
made the basic work for the week. They have published these 
stories in book form, and the book has met a ready sale in schools 
for the deaf throughout the country. 

TESTS FOR STANDARDS 

In the Spring of 1919, the school took the tests in general 
intelligence and in school work, planned by Dr. Rudolph Pintner 
of the Ohio State University, in an attempt to get minimum 
standards for judging the ability of deaf children at various 
ages. He examined about 2500 deaf children throughout the 
country, and from their answers arranged a percentile for each 
year, so that it may be possible to judge the general intelligence 
and work of the deaf child according to his age. In his answer, 
enclosing the returns of our school, he writes : 

"In this grade (the highest year in the school — 8B and 8A) 
we note that the median percentile in the mental tests is 71 and 
in the educational test 89. This would seem to indicate that 
these classes are doing educationally much better than is usually 
found in schools for the deaf." 

Later, in the same letter, he says in regard to results of all 
the classes taking the tests (from 8B through 2A) : "As com- 
pared with other deaf schools, you would seem' to be accomplish- 
ing more than is usually accomplished." 

We are glad to have this assurance that we are working along 
right lines. 

THE PHYSICAL SIDE 

The physical care of our children has, as usual, been carefully 
looked after by our three physicians — our aurist, our oculist and 
our general practitioner. Every new pupil who applies for ad- 
mission is examined, also every child reported by the teacher as 
in poor condition, or specially noted at physical training time as 
needing attention. Not only have they had an examination, 
but they have had special treatment at hospitals where our doc- 



91 

tors have made special arrangements, and in the case of dis- 
charging ears, etc., our nurse has been here every day to give 
treatment. Through the kindness of friends, we still have 13 
quarts of milk at 10 o'clock for undernourished children, and 
our school luncheons, served by our Board of Education, have 
been particularly good. We were obliged to raise the price one 
cent, so that now it costs six cents per child. 

One hundred and ninety children have been examined by our 
physicians ; 56 have received special treatment. 

THE ALUMNI ASSOCIATION 

Our Alumni Association has met regularly on Sunday after- 
noons, once a month. This gives a fine opportunity to keep in 
touch with our boys and girls who have left school. We know 
where they are working, what they find to be the difficulties in 
the world, and how we can aid them and encourage them. 

TRADE WORK 

In response to a questionnaire concerning the work of former 
pupils sent out once each year, we have the following returns for 
this year : 

Number of answers received 104 

Number in hearing high schools 3 

Number in college 1 

Number working (boys, 51 ; girls, 2)7) 88 

Number remaining at home 8 

Number married 4 

Number out of work 3 

Average wages per week (boys, $15.26; girls, $12.19) 
Average length of time in one place (boys, 1 year, 5 
months; girls, 1 year, 7 months) 

Number who have saved money 50 

Number who have Liberty Bonds 32 

Our Industrial Department has had a busy year, especially 
the millinery and the printing classes. They are busy with or- 
ders the year round. We still have no trouble in placing our 
children, and frequently I have more requests for children to 
work than I can fill. The teachers in this department deserve 
a special word of praise. 



92 

In 1915 the average wages per week of our workers was 
$7.15; in 1919 it was $15.16 for the boys and $12.44 for the 
girls. We still meet the problem of the pupil who will not 
"stick" at a job and the one who wants big money at once. But 
they are fewer than they used to be. It is only by personal 
touch we overcome this. 

Very often we receive a letter in which a pupil tells of his 
dissatisfaction, but adds: "I shall stick until I hear from you. 
Please give me some good advice." Then we realize the power 
of the school and the teacher, 

GRADUATES 

Seven pupils were graduated in February, 1919, and another 
seven in June, 1919. In February, 1920, nine were graduated. 
One of the June graduates entered a high school for hearing 
pupils in the Fall. She has done splendid work. Another, a 
congenitally deaf boy, entered De Witt Clinton High School in 
February, 1920. He, too, is doing very well. The others are 
working and succeeding, too. The total number of graduates 
since June, 1911, the date of our first graduation, is 96. 

IMPROVEMENTS HERE AND TO COME 

The installation of electric lighting throughout our building 
has been a great blessing, removing so much of the eye strain of 
the past, and taking away the depressing feeling of dark days. 

The one other great blessing of the year is the promise of a 
new building. This is included in the list of new buildings for 
which our Board is asking. We hope that we shall realize this 
very soon. We feel that much of the absence of teachers is 
due to nervous break-downs caused by teaching in "double 
rooms" — that is, one small room divided by home-made screens 
and made to accommodate two classes all day long. We hope 
to accomplish greater results in our special work — ^^better reading 
of the lips, better speech, and a bigger, broader grasp of lan- 
guage. We want to make these children as normal as we pos- 
sibly can, so that they may measure up to the standards of their 
hearing companions. 



93 



PHYSICAL TRAINING FOR THE DEAF 
Adela J. Smith, Assistant Director of Physical Training. 

PHYSICAL CARE AND SPECIALIZED PHYSICAL TRAINING 

The health care of physically handicapped children is the 
essential basis of their school life. The amount and kind of 
school work which these children may do must be adjusted, 
therefore, to the efforts which they are physically able to make. 

For this reason, therefore, more time has been given to spe- 
cialized physical training- and hygiene for the deaf than to any 
other study, except the multiform subject of English, even before 
the enactment of the Welsh Law. 

It must be considered that over 66 per cent of the children 
attending the School for the Deaf have become deaf through 
serious illness. As a consequence, their vitality has become im- 
paired by the disease causing their handicap. Even congenitally 
deaf children, aside from their heritage, are inferior to normal 
children, owing to their limited facilities for exercise at home. 
City streets and play spaces are dangerous playgrounds for phys- 
ically handicapped children. The school, therefore, must pro- 
vide ample facilities for systematic physical training and ade- 
quate play space for the younger children. 

No amount of subsequent training can eradicate the idiosyn- 
cracies and defects of physical development of the deaf child, 
where, during the growing periods, there has been inadequate 
physical education. These characteristic physical deficiencies 
must be overcome by special devices and methods of instruction. 

There is a noticeable defect in their power of equilibrium 
which produces a characteristic shuffling walk. In running, 
jumping and skipping there is still greater difficulty in maintain- 
ing balance, and the foot is used flat upon the ground in a man- 
ner quite distinctive from the light, graceful, tripping step of the 
normal child. 

Poor posture is another marked defect of deaf children, re- 
sulting not only from an inferior physical condition, but also 



94 




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95^ 

from the poor poise of the body, induced by their impaired sense 
of balance in walking. 

Besides this attention to the improvement of the physical de- 
velopment of the deaf, definite special training must be given to 
correlate methods of speech instruction with those of physical 
education. 

The deaf lack a sense of rhythm and rhythmic continuity of 
movement both in action and speech. Therefore, great stress 
has been placed by the Department of Physical Training upon 
the teaching of rhythm' to all deaf children, through folk danc- 
ing, marching, mimetic and other rhythmic exercises. Further- 
more, deaf children have no speech values. For this reason it 
has been found necessary to formulate various original methods 
and devices of teaching to produce rhythmic motion and thought 
in deaf children. This has been successfully applied through 
specialized physical training. 

The underlying method of instruction is a simple basic prin- 
ciple — that of touch vibration and muscular action. First there 
is an interpretation by the deaf children, of vibration values, 
through the sense of touch by use of a piano or stringed instru- 
ment. Then these time values are expressed in rhythmic mo- 
tion, first through the training of great muscle groups of the 
body and then the application of this training, through the use 
of the finer muscles of speech, to express the same rhythm and 
continuity of motion produced mentally through the larger 
muscle groups. 

It has long been possible to teach the deaf to articulate sylla- 
bles and combinations of syllables forming words and sentence 
construction. The efforts, however, to secure time value in 
speech, showing the relative rest counts given to the comma, 
semi-colon and period, and the natural rhythmic phrasing of con- 
nected and continuous speech has been a more recent study. 

The experiments in this work, through the Depar'tiiient of 
Physical Training, have been conducted by correlating the meth- 
ods of teaching the various rhythmic values in physical training 
with those for speech values. For a time, this work was con- 



96 




97 

ducted in connection with the physical training period. Experi- 
ence has shown, however, that rhythmic training for speech 
values, while taught through the same basic principles underly- 
ing the development of rhythmic physical exercises, must be con- 
ducted at a separate time so that the physiological results of the 
physical training period might not be lost. Eventually, how- 
ever, rhythmic speech exercises would be utilized in the games 
and folk dances, when these have become perfected. 

For this reason, it would be of great benefit to the deaf chil- 
dren to have a special teacher of speech rhythms assigned to this 
school under the training of the Department of Physical Train- 
ing, in order that the same methods of rhythmic training might 
be correlated for speech and exercise and eventually tone pro- 
duction. This training would be in addition to the class and 
speech training each deaf child receives for the production of 
proper enunciation and articulation of syllables, words and 
sentences which would be the basis for this advanced work. 

Special apparatus for this work should be provided through 
an equipment for teaching relative vibration values. A grand 
piano, which gives better vibration for study than an upright 
piano, is needed, and a drum, and also several string instruments, 
such as a 'cello, violin and banjo, should be included in this 
equipment. 

This training in speech values and the modulations of tone 
and power of voice would be of the utmost value to the deaf 
child in his contact with the world outside his school, in aiding 
him to relieve the monotony and uniform emphasis commonly 
noted in the speech of the deaf, and which renders it so difficult 
for those not familiar with it, to understand. 

I am completing now, a system of time values, through touch 
vibration correlated with rhythmic exercises, to effect the trans- 
position of physical exercises to speech, and of motion to con- 
tinuity of speech, which are based upon my studies at the School 
for the Deaf. 

Thus a natural physical basis for speech instruction and even 
tone production can be established, which will be valuable in 
teaching speech and tone values to deaf children. 



98 

FACILITIES AND EQUIPMENT FOR SPECIALIZED PHYSICAL TRAINING 

Special equipment and adequate space for physical education 
are essential in order to conduct this specialized training for deaf 
children. 

The crowded condition of the old school, poor lighting, lack 
of a gymnasium and limited play space have been a great draw- 
back to the development of this work and its application. 

One of the main considerations, therefore, in the planning 
and construction of the new school, should be the provision of 
adequate facilities and special equipment for the physical educa- 
tion of handicapped children. 



TEACHER NEEDED 

An additional special teacher of physical training is needed. 
The rapid increase in the number and types of special classes 
for physically handicapped children has resulted in a decrease in 
the amount of time allowed heretofore to the School for the Deaf 
for the special instruction and supervision of physical training 
and hygiene. This has been detrimental to the progress of the 
work, for the special methods of instruction and device work 
require adequate time for continual supervision. Furthermore, 
new teachers assigned to this school must be instructed in this 
special work. 

SUMMARY 

It is respectfully recommended, in the interest of the physical 
welfare of the children attending the School for the Deaf, that: 

1. The new school be provided with a large, light, sunny 
gymnasium, out-door playground and school garden, a 
roof playground, fresh air classroom and lunch room 
and kitchen. 

2. The administration of the lunch room and kitchen be 
under the joint supervision of the Department of Do- 
mestic Science and the Department of Physical Training 
and Educational Hygiene. 



99 

3. Special playground and gymnasium equipment be sup- 
plied for specialized physical training of the deaf. 

4. Special equipment be provided for the teaching of rel- 
ative vibration values in connection with rhythmic 
speech training and rhythmic physical training. 

5. Elevator service be supplied for the use of cardiac cases, 
pretuberculous children and other physically handi- 
capped children assigned to the school for industrial 
training. 

6. Classrooms and the assembly room be equipped with 
movable adjustable furniture in order to provide great- 
er space for classroom activities and physical training, 
greater freedom for class activities for deaf children 
and accommodations for group work, thus rendering 
but one classroom equipment necessary. This equip- 
ment should include a sanitary cot screen, air pillows, 
blankets, sheets and pillow slips. 

7. A teacher of speech rhythms may be assigned to this 
school for the purpose of providing rhythmic speech 
training in accord with rhythmic physical training, also 
an additional special teacher of physical training for 
physically handicapped children in order that the time 
assigned for special instruction and supervision of phys- 
ical training and hygiene in this school may be not de- 
creased. 

8. A special equipment may be provided for the teaching 
of relative vibration values in connection with rhythmic 
speech training and rhythmic physical training. 



100 



A SURVEY OF CLASSES OF CRIPPLED CHILDREN 

Mrs. Henrietta Rinaldo Scheider, Principal of P. S. 75, Manhattan. 

This survey, made under the direction of the Board of Su- 
perintendents during the Spring term of 1919, describes existing 
conditions and makes recommendations for the improvement 
and extension of the education and training of crippled children. 

CLASSES AND REGISTER 

The number of classes and register of pupils by boroughs is 
found in the following table : 



Borough 


Schools 


No. of Classes 


Register 


Manhattan 


14 


41 


in 


Brooklyn 


13 


29 


571 


The Bronx 


3 


8 


163 



Total 30 78 1471 

KINDERGARTEN CLASSES FOR CRIPPLES 

Borough No. of Classes No. of Pupils 

Manhattan 2 40 

Brooklyn " 2 41 

Total ■ 4 81 

PUPILS IN SCHOOLS AND HOSPITALS AS ANNEXES TO NEARBY 
SCHOOLS WHO HAVE BONE TUBERCULOSIS 

Borough No. of Classes No. of Pupils 

Manhattan 6 110 

Brooklyn 6 113 

Total 12 223 

UNGRADED MENTALLY DEFECTIVE CRIPPLES 

Borough No. of Classes No. of Pupils 

Brooklyn 1 23 



101 

CLASSES IN HOSPITALS AND CONVALESCENT HOMES 

The following classes of crippled children are located in hos- 
pitals, the pupils being- patients of the hospital : 









No. 


of 


No. of 


Borough 


School 


Hospital 


Classes 


Pupils 


Manhattan 


14 


Bellevue 






17 




103 


Deformities and Joint Diseases 






22 




192 


Blythedale Home 






16 




102 


Blythedale Home 






17 


Brooklyn 


91 


Kings County 






22 




91 


Kings County 






19 




91 


House of St. Giles 






16 




29 


L. I. College 






20 


The Bronx 


8 


Montefiore Home 






19 



9 168 

In these classes education is of secondary importance to the 
hospital care. The hospital authorities attest that since the pa- 
tients became pupils they have become better patients. This is 
due to the teacher's influence and to the improved mental attitude 
that comes from interested occupation. 

THE COURSE OF STUDY 

The regular course of study outlined by the Board of Super- 
intendents for the eight grades of the elementary school is fol- 
lowed as far as prevailing conditions in particular instances per- 
mit. The factors that determine the amount of work that can 
be done during any school day or school term are the following : 

1. The shorter school day. 
■ 2. Frequent periods for rest, relaxation and treatment. 

3. Grading of classes, with not less than two grades to a 
class, excepting kindergarten, and frequently with all 
grades from lA through 8B. 

4. The pupil's physical condition. 

Principals necessarily allow great latitude in the interpreta- 
tion of the course of study for these classes. Instruction is 
given to individual pupils or to groups of pupils owing to the 



102 

miscellaneous grading of classes. Promotions are made freely 
from group to group at any time during the year when pupils 
show evidence of ability to do the work of the grade above. The 
interests of these children are limited ; they cannot play freely 
with other children. Their brightest hours are the hours at 
school. They are earnest and persevering. They are so happy 
to be at school, many of them after a long period in hospitals, 
that they apply themselves with delight to their school tasks. 
They are encouraged to forget their handicap and to develop 
a healthy attitude of mind toward work, study and play. 

RETARDATION 

One would expect to find educational progress of crippled 
children much slower than that of other children because of the 
short school day and irregular attendance. 

TRANSPORTATION 

The Board of Education supplies 27 stages, 16 auto buses and 
two automobiles (capacity four and six children) to convey chil- 
dren to and from school. Stages and auto buses make one or 
two trips each per school as required by the number of pupils. 
Stages and buses have capacities varying from 15 to 25 children. 

CAUSES OF DISABILITY 

The principal causes of disability are found to be infantile 
paralysis, tuberculous joints, accident and congenital. The other 
diseases are progressive muscular dystrophy and spastic paraly- 
sis, scoliosis, osteomyelitis, meningitis, rachitis and arthritis. 

It is important that every teacher of crippled children should 
have an elementary knowledge of the different physical disabilities 
which have caused the children to become crippled. 

When children affected by infantile paralysis come to school 
they have no active disease. They can be safely urged to study 
and they are able to do excellent work. 

In many classes pupils having poliomeylitis, bone tuberculosis 
and other disabilities, are grouped together. In some few 



103 




104 

classes of kindergarten and elementary grades, bone tuberculosis 
cases have been segregated. 

NOON DAY MEALS 

It is to be noted that all classes in hospitals are served with 
milk twice daily in addition to the hot luncheon. Proper 
nourishment contributes to the cure, and co-operation with social 
or welfare agencies for a milk supply should be arranged until 
such time as the Board of Education can assume the responsibil- 
ity. The classes in Public School 75, Manhattan, are the only 
ones outside of the hospital classes supplied with milk both 
morning and afternoon. They owe this excellent physical care 
to the East Side Crippled Children's Association. 

Many schools are visited weekly or bi-monthly by nurses 
who confer with the children's teachers and take the children to 
hospitals for treatment. 

The East Side Crippled Children's Free School Association 
provides a well-balanced nourishing noon meal, nicely served in 
a large, fully equipped dining room, to the classes of Public 
School 75, Manhattan, free of cost to the children. It also 
serves milk, bread and peanut butter, or bread and jelly, during 
the morning session and before dismissal in the afternoon. 

Principals and teachers agree that where children enjoy a 
mid-day meal their physical condition responds more readily to 
treatment. They have more endurance both physically and 
mentally from proper feeding. One principal reports a marked 
improvement in the mental and physical tone of the children 
within a short period of two months after the arrangements for 
feeding were made. 

PREVOCATIONAL TRAINING INDUSTRIAL ART COURSE 

The course in industrial art is one means of fitting crippled 
children for working life. The industrial art course for girls 
includes instruction in millinery, making ornaments for hats and 
dresses, and bead work, French flower making, and cotillion and 
dinner favors. The course for boys includes instruction in full 



105 

blockj half block and spur lettering as a foundation for sign 
printing and architectural drawing. Box making, case making, 
modeling, plaster work and pottery are important elements of 
the course, but have been necessarily omitted during the past 
term because of the high cost and shortage of material. Trade 
technique is insisted upon. Graduates report that the skill ac- 
quired in these classes has been of invaluable help in their daily 
work. 

A valuable part of this trade training is the placement of 
pupils in suitable positions upon the completion of the course. 
This has been successfully done by the special teacher assigned 
to industrial art instruction and placement work. 

Industrial Art Instruction was given during the current term 
in the following schools : 

Manhattan— Public Schools 27, 30, 44, 46, 54, 68, 69, 70, 75, 
104, 192; Brooklyn— Public Schools 15, 26, 30, 34, 107, 162; 
The Bronx — Public School 8, Total number of pupils, 1,022. 
Total number of schools, 18. 

The best results in industrial art instruction are shown in 
Manhattan, Public Schools 68, 69 and 75 ; Brooklyn Public 
Schools 34 and 162. 

In each of these schools the principal has departmentalized 
the work and placed it in charge of one teacher. Each teacher 
in charge has devoted time outside of school hours in fitting her- 
self for this work. 

CHARACTER OF THE WORK 

The teacher of crippled children has to deal with a far more 
complicated situation than the teacher in an ordinary class. Each 
of her pupils is likely to vary greatly from time to time in energy 
and capacity, according to his physical condition. There is more 
variation between different pupils than between a similar num- 
ber of ordinary children. A large number of crippled children 
have never been able to attend school regularly or to associate 
freely with other children. The great variation in the children's 
condition and previous experience affects not only their instruc- 
tion, but their discipline. Some crippled children have been 
over-indulged, and must be taught to make independent effort. 



106 

Others have been neglected and must be encouraged to overcome 
their shyness and timidity. 

A special course in sewing is given in Public School 75, Man- 
hattan. The aim of this work is to prepare pupils for self-sup- 
port by means of fine art in the needle craft. This especially 
fine course in sewing is being given to the classes of crippled 
children to articulate the elementary training in sewing with the 
work room maintained by the East Side Crippled Children's Free 
School Association, occupying quarters in the same building with 
the classes at 157 Henry Street. This work room provides 
employment in the needle arts for girls and women. It is al- 
most self-supporting, but is subsidized sufficiently to permit of 
perfect industrial conditions. Both work rooms have been in 
existence for years, and are rendering splendid service by pro- 
viding employment for those who are too badly crippled to com- 
pete in the open market. 

COOKING 

Instruction in cooking is given to crippled children in the 
following schools : 

Manhattan Public Schools— 27, 44, 68 and 75 ; Brooklyn Pub- 
lic Schools — 26 and 35. 

RECOM MENDATIONS 

To realize the intellectual, physical and industrial aim of the 
work, provision should be made for each phase of the problem 
as indicated in the following outline: 

(a) To insure the best physical condition he is capable of attaining 
requires provision for physical care and physical education. 

Physical care calls for — 

1. Transportation to and from school in comfort. 

2. Transportation to and from hospitals for treatment. 

3. Nourishment — the noon hour luncheon and morning and after- 
noon supply of milk. 

4. Nursing — adjustment of braces, massage and electric treatments 
to be given as indicated by the orthopedist in charge of the child. 



107 

5. Co-operation established between the hospital, the school and the 
home by means of nurses' visits. 

6. Medical and surgical treatment. Regular attendance at clinic 
and dispensary. 

The best physical education calls for — 

1. Curative exercises under the direction of a trained specialist. 

2. Opportunities for the enjoyment of free play, within the limits 
of the child's physical disability, in large, open, sunny playgrounds. 

(b) To insure the best education he is able to assimilate calls for— 

1. Complete elementary school training. 

2. Special high school training for those whose physical condition 
does not permit them to attend regular high school classes. 

3. Adequate elementary trade training. 

4. Post-graduate industrial classes for those unable to attend regular 
classes of trade or technical schools. 

(c) To insure the best job he is competent to undertake demands — 

1. Adequate provision for trade training. 

2. Placement in industry of those not too badly disabled to compete 
in the open labor market. 

3. Specially provided working conditions and employment for those 
not fitted to enter into ordinary business competition. 

4. The extension of the advantages of the industrial art instruction, 
to the home bound cripple. 

5. Work for the home bound cripple articulating with the above 
instruction. 



CONCLUSION 

My survey of the classes for crippled children reveals a wide 
difference among the respective classes in the advantages for 
physical, intellectual and industrial education. Some enjoy a 
maximum of advantages. Others have little that justifies us in 
calling them special classes. 



108 

To equalize educational advantages, providing the best for 
all classes, I recommend: 

1. Unified control of these classes to bring about — 

(a) A plan which will find all the crippled children who ought to 
be receiving the attention of one or more of these agencies ; out-patient, 
social, educational, vocational, and transportation service. 

(b) A system of continuous record to prevent overlooking and 
overlapping. 

(c) A system to meet all transportation needs of crippled children 
to schools, to clinics, to work. 

(d) A system of follow up care on the discharge of cripples from 

hospitals, from schools, from employment. 

2. The standardization of forms of organization and methods of 
teaching cripples. 

3. Study of openings in industry as a basis for selection of trade 
training of different localities. 



109 




110 



CRIPPLED CHILDREN 

Adela J. Smith, Assistant Director of Physical Education. 

HISTORY 

New York was the first city in the L^nited States to provide 
special classes for crippled children in public schools. For 14 
years the Department of Education has conducted these classes 
so that these physically handicapped children might receive the 
same educational advantages as other children, and at the same 
time have the protection provided through a special class with 
technical supervision of their physical deficiencies. Further- 
more, this segregation has relieved the larger school organization 
of the responsibility of handicapped children. 

This care of physically handicapped children through one of 
the city organizations, now the Association for the Aid of Crip- 
pled Children, began in 1899 in one of the school buildings off 
the Children's Aid Society. Seven years later, the success of - 
this undertaking led to the formation of the first special class for 
crippled children in Public School 104, Manhattan. In that 
same year, the classes of crippled children under the caje of the 
Ladies' Auxiliary of the Lehman Foundation were arai^ed to 
Public School 147, Manhattan, with a total register of approxi-. 
mately 138 crippled children. Gradually the classes of cripples 
conducted through private philanthropy have l^ecome a pe'rma-' 
nent feature of the public school system. 

GROWTH ^ ^f 

Classes have been formed in Manhattan, Brooklyn, the Bronx'; 
and Queens. Two thousand and forty-nine crippled children- 
are now registered in 96 special classes in 42 public schools and 
hospital annexes in four boroughs of the City of New York. 

The 1916 poliomyelitis epidemic has added a long Htt to the 
crippled children, who will need special school/'accommodations 
and transportation in New York. -S' ., 

In reviewing the summary of the 6,294 cases reported by the 
New York Committee for the Care of Paralysis^.Cases^;l',92r 
crippled children will require special school care. The youngest 



Ill 

children of this group will be of school age in 1921. At this 
time, this list of poliomyelitis cases will have more than doubled 
the 1916 registration in classes for crippled children. 

TYPE OF SPECIAL CLASSES 

When special classes in public schools, and transportation, 
were provided, it seemed that the educational needs of crippled 
children had been met. As this movement progressed, howevei-, 
it became evident that a large number of crippled children under 
treatment in hospitals were receiving no education. Further- 
more, an ever-increasing list of helpless crippled children was 
reported. All these children were too greatly handicapped to 
permit their attendance in special classes in public schools. Many 
of these children could neither read nor write. 

To meet the urgent pleas for educational facilities for these 
two groups of crippled children, special classes were formed in 
hospitals as annexes to the nearest' public schools. Visiting 
teachers were provided also this year for the instruction of help-f 
less crippled children, in academic subjects and occupational train- 
ing in their home to bring these "shut in children" in touch with 
the outside world. ;-{ 

The type of school care for crippled children associated with 
the public school system of the City of New York is arranged, 
therefore, in accordance with the type of case as follows : 

SPECIAL CLASSES IN PUBLIC SCHOOLS 

The placing of special classes for crippled children in public 
schools was the result of a demand for a school atmosphere for 
this segregated group, as nearly as possible like that of normal 
children, while providing protection and technical supervision of 
their physical defects. This movement voiced the sentiments of 
both parents and children more than any other activity that has 
been established in recent years, for physically handicapped chil- 
dren. They want to do the things which other children do; 
they want to study the same lessons, play similar games, and go 
to the same schools. In placing these classes in public schools, 
therefore, the crippled children feel that they are as much a part 
of that school system as their more fortunate brothers jind sisters, 



112 




113 

CLASSROOMS AND EQUIPMENT 

The special classrooms selected for the use of crippled chil- 
dren are near an exit and the playground, and are located upon 
the ground floor, to eliminate excessive stair-climbing for physi- 
cally handicapped children. Preferably, corner rooms are 
chosen, with either a southeasterly or southwesterly exposure so 
that sunshine may be obtained for practically all the school day, 
and direct ventilation, even during stormy weather. %, 

These rooms are equipped with special adjustable furniture' 
suitable for the care and comfort of cripples. 

TRANSPORTATION 

Transportation is provided for crippled children who are 
physically unable to walk short distances to school or to use the 
street cars. The stage districts are so regulated that no child 
travels in a school stage more than 45 minutes, in each trip. 

INSTRUCTION 

The course of study, especially for nontuberculous crippled 
children, is similar to that for pupils in regular classes, although 
more time is allowed for preparatory work in industrial training. 

The amount and kind of mental and physical work which 
each child is permitted to do is based upon the recommendations 
made on the hospital record cards by the speciahst treating each 
child. 

DAY SCHOOL FOR CRIPPLED CHILDREN 

There is at present one day school for crippled children con- 
nected with the pubhc school system. It has U classes with a 
registration of 200. This school is the Crippled Children's East 
Side Free School— Public School 75, Manhattan. 

The teachers of academic instruction and specialized physical 
training, and supervisors, are assigned through the public school 
system. The special classroom equipment, school supphes and 
rent are provided also by the Department of Education. 

The advanced instruction in industrial training and the work 
shop are conducted by the Board of Directors of the Lehman 
Foundation, through which fund other running expenses of the 
school are paid. Through this foundation free medical treat- 

8 



114 




115 

ment, nurses' services and baths are dispensed in the school cHnic. 
Morning and afternoon lunches and an excellent dinner are 
served daily to the children without cost. Furthermore, sum- 
mer vacations are arranged by the Directors for all the children 
at the summer home of this school. 

This type of school for crippled children is particularly 
adapted to the congested part of the city where the work of prac- 
tically all of the parents and older members of the family keeps 
them from home all day. Owing to these conditions, the chil- 
dren are unable to receive systematic treatment at the City clinics 
where most of the other orthopedic cases are treated, and it is 
therefore provided during the school day at the school clinic. 

Transportation is provided, mainly by the Department of 
Education, although two stages are supplied through the Lehman 
Foundation for the pupils in the work shop and some of the 
grade pupils. 

HOSPITAL CLASSES 

These classes were organized for the school care of crippled 
children who are under treatment in hospitals for two months or 
longer. Many of these children, especially the cases of bone 
tuberculosis, remain in hospitals for years, and in consequence, 
have been without systematic school training before such special 
classes were organized. Formerly these children had such in- 
struction and amusement only as occasional visitors were willing 
to give. Later, through private philanthropy, several classes 
were established for the ambulatory cases in some of the hospi- 
tals. The success of this experiment has resulted in the estab- 
lishment of special classes in hospitals under public school super- 
vision, at the request of the hospital superintendents and ortho- 
pedic surgeons. These classes include the ambulatory cases 
mainly. The bed cases receive individual instruction. 

In some hospitals, helpless crippled children and the severe 
cases resulting from the 1916 poliomyelitis epidemic are admitted 
to these classes from the out-patient department, because they 
still require such frequent hospital care that school attendance is 
otherwise impossible. Furthermore, these children are profit- 
ably occupied while waiting for their turn for trea;tment. 



116 




117 

The hospital authorities and surgeons are much pleased with 
the results of this movement for providing education facilities 
for crippled children in hospitals. The interest and pleasure 
which the children take in their daily occupation has reacted 
favorably upon them physically. Many of the surgeons have 
stated that the time of treatment in many instances has been re- 
duced because of this mental reaction upon the physical condi- 
tion of the child. Furthermore, the parents are more willing 
to have their children remain at the hospital until treatment is 
completed, for neither children nor parents are worried over 
their school progress, which heretofore was necessarily inter- 
rupted by long periods of absence from school. 

HELPLESS CRIPPLED CHILDREN 

In May, 1915, at a conference with the directors of the Fed- 
eration of Association for Cripples, it was found possible to se- 
cure their co-operation with the Department of Physical Train- 
ing in providing visiting teachers by way of an experimental 
study for the instruction of helpless crippled children in their 
homes. 

As a result of this conference, one teacher was appointed im- 
mediately, and the following term several volunteer teachers of- 
fered their services for instruction in both elementary school 
subjects and industrial work. Records show that by December, 
1916, 26 helpless crippled children under 16 years of age were 
under instruction through the services of volunteer teachers. 
Forty-five volunteer teachers and one paid supervising teacher 
were employed during the period from December, 1916, to 
March, 1918. 

The teachers visited the children usually twice each week, 
and reports were rendered every two weeks concerning the 
progress of each child. Books and supplies were received from 
the nearest public school. 

This experimental study showed most satisfactory results. 
The home visits proved to be a source of great pleasure and profit 
to the children, and furthermore, the anxiety of parents concern- 
ing the education of these helpless crippled children was greatly 
relieved. 



118 

The practical results of this experiment caused the parents of 
other helpless cripples to make persistent pleas for the extension 
of this work. During 1918, 92 helpless crippled children re- 
ceived home instruction in both elementary subjects and indus- 
trial work for varying periods through the services of volunteer 
visiting teachers. 

By December, 1918, 125 crippled children of school age, with 
normal minds, were listed for the services of volunteer visiting 
teachers, because their physical condition made it impossible to 
transport them to school. When the summary of the statistics 
of the recent poliomyelitis epidemic showed as a pitiful result 
270 helpless crippled children, 35 of school age, 29 of kindergarten 
age, and 206 of five years or younger, it became evident that the 
number of children requiring home instruction would increase 
each year. 

ASSIGNMENT OF PUBLIC SCHOOL TEACHERS 

This work had now outgrown its experimental stage, and it 
was evident that the time had come when the instruction of these 
children should be carried on by the Board of Education as the 
most systematic and continuous way of providing an elementary 
school education, and also' industrial training. Consequently, a 
report was made upon this experimental study with recommenda- 
tions for the employment of substitute teachers under the super- 
vision of the Department of Education. This report and recom- 
mendation was approved by the Board of Education in 
December, 1918. These recommendations included: 

1. The employment of twenty substitute teachers to give instruction 
in the elementary school subjects and in industrial work. 

2. These teachers to receive technical training in hygiene and methods 
of instruction of crippled children through the Department of Physical 
Training. 

3. Books and supplies to be furnished from nearby schools when re- 
quested by the visiting teacher and indorsed by the district superintendent 
in charge of the schools. 

4. A record of the condition of each child receiving instruction, the 
work carried on, and the progress made to be recorded at the close of 
each month. 

5. The co-operation of the Federation of Association for Cripples to 
be continued in order that volunteer service be secured whenever it was 
deemed advisable. 



119 

6. A canvass to be made for all cases of helpless crippled children of 
school age. 

It is worthy of note that the report was presented in such a 
convincing manner that it was approved by the Board of Educa- 
tion, and in February, 1919, 20 visiting teachers were assigned 
for service as home teachers for the instruction of helpless 
crippled children. 

PLAN OF WORK 

During the term from February to June, 1919, 20 visiting 
teachers were assigned to this special instruction. By June, 
1919, 160 children were receiving home instruction and 265 cases 
had been investigated. These teachers gave instruction in ele- 
mentary school subjects three times a week for one and one-half 
hour each visit for every pupil, and thus full time teachers 
working six days per week instructed eight children. 

In June, 1919, there was an extensive waiting list of helpless 
childen, including cripples, severe cardiac cases and epileptics 
requiring the service of visiting teachers. Additional funds for 
this work was required and granted in the Budget of 1920. 

In January, 1920, 36 visiting teachers were appointed. Of 
these, 18 were after-school visiting teachers from nearby schools, 
who were assigned to helpless children residing in outlying dis- 
tricts at some distance from a visiting teacher's circuit, and also 
to helpless cripples who were preparing to graduate. Each 
after-school teacher gave instruction for four afternoons each 
week. 

Books and supplies were obtained through the district super- 
intendent in charge of the nearest school having a class of 
crippled children, in which the helpless crippled child was regis- 
tered as a member of that class. 

After the first visit to the home of each child by the visiting 
teacher, a report of this visit was made and a copy forwarded to 
the Department of Physical Training. This included a tentative 
examination of the mental attainment of the child, and also a 
record of his physical disability, medical and surgical treatment, 
name of hospitals attended and physicians giving treatment. The 
child, if able to profit by home instruction, was then reported for 
registration on the roll of the nearest school. As a result of 



120 

this first visit, the child was graded and the plan of work for 
each child for the month was outlined in accordance with the 
grade in which he was registered in the school. Careful adjust- 
ment of this plan of work for the month was made by the visiting 
teacher through visits to this school in conference with the prin- 
cipal and class teacher of crippled children. 

In cases of the serious illness of one of these children or in 
instances of quarantine in contagious diseases, the visiting 
teacher, after notifying the Department of Physical Training for 
investigation gave the time of this child as additional service to 
the other pupils on her assignment until the sick child was physi- 
cally able to continue his studies. When children were sent to 
the hospital for an operation or prolonged treatment, a new 
assignment was made to the visiting teacher from children on the 
waiting list. In cases where the hospital treatment extended 
over more than three or four weeks, the child was either ad- 
mitted to a class for crippled children in the hospital, or, if the 
hospital had no such accommodations, the visiting teacher was 
reassigned to the instruction of the child in the hospital upon the 
recommendation of the physician in charge. 

In June, as an experimental study, examinations similar in 
character to those conducted by the principals in the school in 
which each child was registered, were given by the visiting 
teachers and used as a basis for promotion. As a result of this 
plan, two helpless crippled boys completed the work of the eighth 
year and passed the examination of the principals and district 
superintendents in a satisfactory manner. All the other chil- 
dren, with the exception of those who were admitted to hospitals 
or were convalescing from operations or diseases, were advanced 
to the next grade in June, 1919. A number of the children were 
so interested and anxious to progress in their school work, that 
they covered the work of two grades by June. In February, 
1920, two more helpless boys graduated, and in June, 1920, an- 
other will have completed eighth -year work satisfactorily. Two 
of these boys are now receiving home instruction in typewriting 
and stenography, and shortly will be able to earn their living 
through their own efforts. 



121 

This procedure has given great satisfaction to both parents 
and children, for they feel that these helpless crippled children 
have at last become associated with other children in their educa- 
tion and school training. 

PHYSICAL RECORDS 

The history and records of the physical disability causing the 
handicap, were obtained from the parents of each helpless 
crippled child listed for the services of a visiting teacher. Each 
case was carefully investigated by the Department of Physical 
Training, with the efficient aid of the Federation of Association 
for Cripples, and where either medical or surgical treatment was 
needed, this was instituted. Over 260 cases of helpless crippled 
children were investigated last term, and hundreds of parents 
were interviewed. In many instances, parents had become com- 
pletely discouraged by what appeared to them to be a hopeless 
situation. Superintendents of hospitals, surgeons of orthopedic 
clinics and other children's specialists were ccmsulted and inter- 
ested to co-operate in the treatment of these children. As a re- 
sult, 19 helpless crippled children were so improved physically 
that they were able to attend classes for cripples or other classes. 

VOLUNTEER VISITING TEACHERS 

The services of the volunteer visiting teachers, supplied 
through the Federation of Associations for Cripples, were re- 
tained for instruction in industrial work, hand training and recre- 
ation. The visits of these teachers alternated with those of the 
public school visiting teachers. Some of these volunteer 
teachers were experienced workers in trades and industrial arts, 
and after a busy day gave their time to the instruction of these 
helpless children. 

Recreation is planned also by the volunteer visiting teachers 
through their own efiforts and by interesting influential friends. 
Automobile rides are arranged, trips to Coney Island and the 
parks, entertainments and picnics, visits to museums and even 
the moving picture shows have entered the lives of these home 
bound children, giving untold happiness to them. 



122 



CRIPPLED CHILDREN 

RESULTS OF POLIOMYELITIS EPIDEMIC — 1916 

The results of the 1917 survey of the New York Committee 
on the After-Care of Infantile Paralysis, of the children affected 
by this epidemic, have been summarized in the following tabula- 
tion under age headings, in order that an estimate might be made 
of the number of special classes that would be required. 

94 cases between the ages of 10 and 15 years in 1916. 

56 cases between the ages of 9 and 10 years in 1916. 

178 cases between the ages of 8 and 9 years in 1916. 

127 cases between the ages of 7 and 8 years in 1916. 

160 cases between the ages of 6 and 7 years in 1916. 

245 cases between the ages of 5 and 6 years in 1916. 

412 cases between the ages of 4 and 5 years in 1916. 

693 cases between the ages of 3 and 4 years in 1916. 

1,098 cases between the ages of 2 and 3 years in 1916. 

1,398 cases of the age of 2 years in 1916. 

793 cases of the age of 1 year in 1916. 

192 cases under 1 year of age in 1916. 

Fromi this it is evident that 860 children of school age were 
under treatment in 1916, to which may be added 412 children of 
kindergarten age, or 1272 crippled children. To this must be 
added, in 1918, 1105 crippl'ed children who are now of school 
age, and 1098 children of kindergarten age, making 1905 children 
of elementary school age and 1098 children of kindergarten age, 
or a total of 3003 children. To this record should be added 200 
cases not Hsted in this tabulation, and found to be without treat- 
ment, later. 

Through systematic and special hospital care and treatment 
during the two years from 1916 to 1918, some of these children 
have been cured and others aided, so that although somewhat dis- 
abled, they may attend regular classes in public schools. 

In order to ascertain the present physical disability of each 
child listed in the survey of 1917, a complete inspection of each 
case was made from June to October, 1918, through the helpful 
co-operation of the New York Committee on After-Care of 
Paralysis, Dr. Frederic Splint, Director. 



123 

The following summary of this comprehensive survey indi- 
cates the number of crippled children v^ho must have special 
school accommodations in 1918 and 1919. 

DEDUCTIONS 

Of the total number of 6256 cases of children afflicted with 
poliomyelitis during the epidemic, and reported in this recent sur- 
vey, the following school care is indicated for the children of 
kindergarten and school age. Not counting the 910 cases in 
which the ages were not given, approximately : 

418 cured cases of school age, and 

258 cured cases of kindergarten age, could be referred to 

regular classes in the public schools. 
418 cases with slight disability of school age, and 
258 cases of kindergarten age, could be referred for accom- 
modation in regular classes in a public school, with a 
letter to the principal requesting a report of progress in 
case the child could not stand the physical strain of reg- 
ular class work. 
434 cases of severe disability of school age, and 
307 cases of kindergarten age, should be registered in 
classes of crippled children. 
44 helpless cripples of school age, and 
36 helpless cripples of kindergarten age, should be regis- 
tered in hospital classes or provided with visiting 
teachers. 

To this number must be added 125 cases of helpless cripples 
who received home instruction during the past year, or 205 cases. 

There are, therefore, 418 crippled children of school age and 
258 crippled children of kindergarten age in the five boroughs, or 
a total of 676 cases requiring transportation and school care in 
special classes in the public schools. To this must be added 80 
helpless cripples, who will be accommodated in hospital classes 
or who require a visiting teacher, or a total of 756 crippled chil- 
dren. This is equivalent to a register of 35 special classes, and 
will require approximately 20 stages for transportation. At 
one sudden, unfortunate blow, therefore, the number of children 



124 

requiring special school accommodation has been increased by 
nearly 64 per cent, of the registration of May, 1918. It will be 
1922 before all the cripples of the 1916 epidemic are accommo- 
dated in special classes. 

SUMMARY 

For the physical welfare of crippled children under public 
school supervision, permit me to respectfully recommend that : 

1. Thirty-two visiting teachers be provided for the home 
instruction of helpless crippled children during the 
school year. 

2. Transportation for crippled children in public school 
classes, including accommodations for such service to 
hospitals to encourage systematic and continuous treat- 
ment ; and to secondary and vocational schools for spe- 
cial schools for special training. 

3. An eligible list be prepared of teachers of classes of 
cripples with a schedule equivalent to that of a promo- 
tion license, and that special training for assignment to 
special classes be required. 

4. Special provision be made for playgrounds and teachers 
for all crippled children in hospitals, clinics and conval- 
escent homes for the summer vacation. 

5. Another special teacher of physical training be assigned 
to assist in the instruction of physically handicapped 
children. 



125 



INDUSTRIAL AND PLACEMENT WORK FOR PHYS- 
ICALLY HANDICAPPED CHILDREN 

Carolina G. Ronzone 

PURPOSE 

The purpose in this work is the preparation of boys and girls 
for useful employment in the trades, according to their handicap. 
As the greater percentage of them leave school at the age of 15 
or 16, the work planned for them is kept closely allied to the 
fundamentals of the trades they anticipate entering. Elementary 
school children cannot become skilled workers, and experience 
proves that the foreman has his own methods and would rather 
carry the children on to skill in his own way. This not only re- 
lieves the school authorities of expensive equipment, but it places 
within reach of education a means of insuring, with ,very little 
expense, the apprenticeship for the child. 

The work of the teacher is to study carefully each peculiar 
handicap and individual tendency, to find the occupational possi- 
bilities, the methods used in the trades, and then to educate the 
child. 

AIM 

The elementary work aims to train the children to use their 
fingers and tools correctly in handling material, working entirely 
from nature. It develops form, color, trade processes by free- 
hand cutting and making of objects. It also trains the eye in 
correct proportion and teaches perspective. The details learned 
in the elementary grades of making fruits, vegetables and flowers ; 
bead charts, millinery charts, elementary construction and model- 
ing lead to the following trades : 

Cotillion favors, dinner favors. 

French flowers, satin flowers — used in millinery. 

Needlework — relating to silk novelties. 

Millinery— which includes all processes from the making of the frame 

to the finished product and the renovation of old hats. 
Beading, fringing, tassel making. 

This course correlates with the sewing department. A girl who 

can sew and also make these accessories to a dress is a valuable 

acquisition in a work room. 



126 

Lettering. This course embraces the formation of different type let- 
ters as full block, half block, spur block, which are all built ac- 
cording to different ratios by the aid of mechanical instruments, 
T, square, angle, etc., and leads to the detail work in an architect's 
and designer's office and to ornamental glass sign painting. Later 
the scale of these letters is lowered by the eye and gold leaf and 
other mediums are used to decorate them. This course correlates 
with printing and shop work. , 

Elementary Construction— which teaches the processes of cornering- 
out, scoring, setting-up, stripping or covering, and the correct ma- 
nipulation of the mediums employed, as paste and glue. 

Typewriting and Machine Calculating. This work correlates with the 
academic branches and is given to boys and girls who do not care 
to handle industrial work. 

Weaving, Basketry, Brushes, Chair-caning. 

This type of work should be set apart for the blind, mentally de- 
fective, and those so badly handicapped that this is all they can 
do. The best trades are now open to the deaf, crippled and other 
handicapped children offering training and a splendid future. 

ADJUSTMENT OF TIME SCHEDULE 

An adjustment should be made in the time schedule so as to 
give these children more time for hand work, for as it now stands 
the major part is given to the academic subjects. This adjust- 
ment is necessary in order to meet the needs of the boys and girls 
entering the trades at the early age of 15 and 16. It would be a 
good plan to give the children entering the trades six months of 
intensive training in their special trade before graduation. For 
those who are preparing for office work, telegraphy, typewriting, 
machine calculating, filing, etc., it would be well to give extra 
work in academic training. 

Where there are four or five classes of handicapped children 
in a school, a special industrial room is advised with one teacher 
in charge of the work. This plan is in operation at Public School 
69, Public School 75, Manhattan, and Public School 34, Brook- 
lyn, and the results for the current year demonstrate the value of 
it over all other methods. Each class receives 40 minutes' in- 
struction daily, and while the teacher in charge is in the shop, the 
academic work is being taught to her class by the teacher of the 
class, which is in the shop. This plan is also in operation in the 
School for the Deaf. 



127 

Handicapped children are now receiving industrial training in 
the School for the Deaf, eleven schools for cripples in A^Ianhattan, 
six in Brooklyn, and one in the Bronx. This year two schools for 
cripples, twO' for tuberculous, one for anemic children in open air 
class, and one for blind have been added in Manhattan and the 
Bronx and four for cripples in Brooklyn, making a total of seven- 
teen schools in Manhattan and ten schools in Brooklyn. Eventu- 
ally the work will be extended to the other schools where there 
are classes for handicapped children. 

Only three schools for crippled children have an extra room 
to give to industrial work, and they are equipped as follows : 

Four tables, twelve regular chairs, ten small chairs, eight 
stools. 

In schools not having special industrial rooms the work is 
carried on in the regular class rooms. 

WORK AT THE SCHOOL, FOR THE DEAF 

The work of educating the handicapped child for the trades 
was first begun in New York City at the School for the Deaf. In 
the beginning it seemed a hopeless task, but with the loyal co- 
operation of heads of educational departments, representative 
business men, and medical specialists, these children have won 
their fight for independence, and have victoriously entered the 
ranks of the industrial world. 

The placement work is steadily growing. The demand for 
the deaf as workers in the trades is greater than the supply, and 
statistics show that it is a rare case for one to make a change of 
position within the year. 

There were 22 graduates in February and June, 1918, 14 in 
February and June, 1919, and 16 in February and June, 1920, 
making a total of 52 in 1918-1919-1920. Two entered high school 
and the remainder entered the trades of printing, glass signs, mil- 
linery, French flowers and power-machine operating. Investiga- 
tion shows that all graduates of this and former years are em- 
ployed and earning good salaries — minimum $8 and maximum 
$30 per week. 

The placement of the crippled child is mainly conducted 
through the various organizations interested in the after care of 



128 

cripples. All graduates thus far have either entered high school 
or have been placed in the trades. There were 21 graduates in 
February and June, 1918, 21 in February and June, 1919, and 75 
in February and June, 1920, making a total of 117 in 1918-1919- 
1920. Wider opportunities will present themselves, but the place- 
ment record up to date proves that all physically handicapped 
children trained under the right conditions will make good. 

Heads of firms have become so interested that an association 
of business men now co-operate in furthering the trade interest 
of the handicapped. The sale of the product of handicapped chil- 
dren while they are in school is not encouraged, but the use of the 
actual materials is employed as far as possible to give them real 
trade experience. In this we have the co-operation of the trades 
people who are willing to send the working materials to the schools- 
Many handicapped children whose parents have asked for their 
release have been retained in school to graduate by finding for 
them afternoon and Saturday employment. Business men in 
Greenpoint, Brooklyn, are to open a room in which to employ 
those children who cannot travel far, and firms will send their 
work to them. 

In some of the hospitals where the public school work is now 
being carried on, the doctors and nurses have become interested 
and are asking that a training class for nurses be organized so 
that they may give the work to the adult cripple in the wards. 

TRAINING CLASS FOR TEACHERS 

There is no special corps of industrial teachers to assist in this 
work. It has been the work of the one special teacher in charge 
of this work to instruct the classroom teacher, and for this pur- 
pose a training class has been voluntarily carried on at the School 
for the Deaf. 



129 



REPORT ON SPECIAL CLASSES FOR CARDIAC CASES 

Adela J. Smith, Assistant Director of Physical Training 
Frances Cohen, M. D., Assistant Director of Educational Hygiene 

FORMATION OF CLASSES 

The formation of special classes for cardiac cases in the public 
schools of the City of New York was due to the evident need for 
group segregation and special hygienic care for children afflicted 
with severe cardiac disturbances. These classes were formed, as 
an experiment, to accommodate the numerous cardiac cases re- 
ported by principals who, in the administration of their school 
activities, found it necessary to provide special protection for this 
type of physically handicapped children, who were unable to keep 
pace with the normal children in regular classes. 

Surveys were made in various schools, and all the children 
were examined by medical inspectors, and records were made of 
children suffering from cardiac disturbances. Later, these cases 
were referred to special cardiac clinics in hospitals selected for 
this purpose, and here detailed re-examinations by the cardiac 
specialists in these clinics were made. 

TYPE OF CASE 

Through these examinations, a selective type case was ob- 
tained, for which special school care was recommended. The 
group selected for this care included well-marked cases of organic 
heart disease. No cases of so-called functional heart disturbances 
were included. 

This selective type of cardiac case, generally Class III, con- 
stituted the policy behind the formation of special classes for 
cardiacs in public schools. It was found to be advisable to have 
each case selected in this manner, associated with the special car- 
diac clinic in the school district in which this special class was 
formed, in order that frequent examinations by the cardiac spe- 
cialist could be made as the basis for the kind and amount of 
school work the child might undertake, and also that he might be 
under the supervision of the nurse associated with the clinic. 



130 



HOSPITAL RECORD CARD 



The following is a copy of the hospital record card. The form 
is based upon the one used so successfully in the care of crippled 
children in special classes in the public schools. 





DEPARTMENT OF EDUCATION THE 
HOSPITAL RECORD CARD- 


CITY OF NEW YORK 

CARDIAC 


Name 




Last First 




Date of Birth 




Address 






Floor 




Name 


of teacher 










School 




Borough 


Date 


entered 


Grade 


RECOMMENDATIONS FOR PHYSICAL TRAINING 



Check Exercises Indicated 

Gymnastics 



Breathing exercises 



-or improvmg posture 



For alert response — control 



For physiological (circulatory) results 



lass Room — Seat Games 



Recreative Elxercises 



(Cla 

f Adapted Playground Games 



Quiet Games 



Exercises Contra 


Indicated 




















Should the child 


rest (prone) 


in schoo 


? Yes 


No 


How 


long ? 










RETURN TO OFFICE OF DIRECTOR OF PHYSICAL TRAINING, 

Last First 

Name Date 


157 East 67th St., 


N. 


Y. 


C. 


Hospital 












Physician 








Diagnosis 























Cardiac Classificahon (Class I. II. III. IV. V.) 


Check (V) type of case in columq. 






I. Organic (Sympts. of Insufficiency— never evident) 




IV. "Possible" Cardiac disease 

(Doubtful Murmurs: Mainly functional, 
possibly organic) 






II. Organic ( _pa,t. not present) 




III. Organic ( -present ) 




V. Potential (Predisposing history) 







Should the child be in a hospital ? 


Yes. No. 


If not, is he physically able to attend school ? 


Yes. No. 


Should he be in a special class for cardiacs ? 


Yes. No. 


Should he be permitted to climb stairs ? 


Yes. No. No. of flights 


Physical Defects. 


Def. Vision Yes. No. Def. Hearing Yes. No. 


Discharging Ears Yes. No. Def. Teeth Yes No. 


Def. Nasal Breathing Yes. No. Chr. Nasal Discharge Yes. No. Hypertrophied Tonsils Yes. No. 



Nutrition Grading I - 2 - 3 - 4 Pulmonary Def. Yes. No . Chorea Yes. No. 
Code : Nutrition Grading I Excellent. 2 Good- 3 Fair. 4 Poor, 



131 

The method of classifying the various types of cardiac disease 
and the degree of disabihty are in accord with the diagnostic 
scheme adopted by the Association for the Prevention and Relief 
of Cardiac Disease. 

The school attendance and the amount and kind of school ac- 
tivity permitted each child is varied in accordance with the recom- 
mendations made by the cardiac speciahst, as shown by the records 
on this card from month to month. This medical record is later 
transcribed by the Department of Physical Training in terms ap- 
plicable to the school care of the child, for the use of the class 
teacher. 

CO-OPERATION BODIES 

Experimental classes were organized in 1918 in Public School 
168, Manhattan, in conjunction with the special cardiac clinic in 
the Dispensary of the Mt. Sinai Hospital, and in the Educational 
Alliance— Public School 75 Annex— which is associated with the 
cardiac clinic of the Beth Israel Hospital. 

These two clinics represent two of those established under the 
recommendation and auspices of the Association for the Preven- 
tion and Relief of Cardiac Disease in zoning the city for the relief 
of cardiac cases. 

ADMISSION AND DISCHARGE OF CARDIAC CASES 

The administrative procedure governing the admission and 
discharge of children assigned to these special cardiac classes is 
based upon the recommendations made by the cardiac specialist 
upon the hospital record card of each child. Frequent re-exam- 
inations are made by the physician of the clinic as a basis for the 
continued school care. 

CLASSROOM — TEMPERATURE VENTILATION 

It has been found necessary to select suitable classrooms for 
the special school care of cardiac cases. These rooms should be 
preferably upon the ground floor, or not higher than one flight of 
stairs, and should have plenty of sunlight and fresh air. A corner 
room with a southeastern or southwestern exposure is, therefore, 
desirable. The room should be located near an exit and within 
easy access to the playground, 



132 

The temperature of these rooms should not be lower than 60° 
F. during the season when artificial heat is required, and at this 
time the children should be warmly clad, even to the extent of 
wearing sweaters, mittens, caps, and if necessary, leggings, in or- 
der to prevent circulatory disturbances by prolonged lowering of 
body temperature. 

FEEDING IN SCHOOL 

From observation, it has been found an advantage to supply 
the midday meal at school in preference to having the children 
walk to their homes at noon time, especially during inclement 
weather. Special care has been taken to supply a well-balanced 
diet, eliminating free sugar, with a minimum of meat, meat broths 
and fluids. Three meals a day, about four or five hours apart, 
have been recommended with no lunches between meals except a 
hot drink on cold days after the afternoon recreation period. A 
rest period is provided during the school day after the noon meal. 

DAILY MORNING HYGIENE INSPECTION 

A comprehensive morning inspection of the children is made 
daily by the teachers in charge of these special classes. Emphasis 
is placed upon any sign that would indicate an increase in cardiac 
disturbance, such as unusual rapidity of pulse, or of respiration, 
flushed face, extreme pallor, labored breathing, blue lips and 
fingers, profuse perspiration and general weakness or languor. 

In addition to observing signs of illness, a careful inspection 
is made of each child from the standpoint of cleanliness and kind 
and amount of clothing worn. It is especially important that these 
children should be provided with warm underwear during the 
winter months, so that they do not sufifer from circulatory disturb- 
ance resulting from prolonged cold. The teachers ascertain if 
these conditions are fulfilled. 

Emphasis is' placed upon the importance of good mouth 
hygiene, sufficient number of hours of sleep at home, the quality 
and quantity of food, and the general home hygiene and care. 
The teachers are assisted in the health care of these children by 
the nurse assigned for home visits, through the special cardiac 
clinics. 



133 



DAILY MEDICAL INSPECTION 



Besides the general and special morning inspection, the nurse 
associated with the cardiac clinic should take the temperature of 
each child twice a day, at 9.00 A. M. and at 3.00 P. M., to serve 
as a guide for the school care during the day and for the after 
school recreation period. 

A study of body temperature was made in two classes on vari- 
ous groups of children for a period of a month each in order to 
ascertain primarily whether children afflicted with organic heart 
disease are subject to abnormal fluctuations of temperature. The 
records of the temperature charts obtained from these observa- 
tions show, beyond a doubt, that a large number of children suf- 
fering from heart disease run an abnormal temperature. 

It is significant that in a study of 15 cases, all organic heart 
cases had an abnormal temperature, and that 80 per cent of the 
cases showed an elevation of temperature more than 50 per cent 
of the time, while the congenital case had temperature a very short 
time. 

The fact, therefore, that these children, aside from having a 
mechanical physical defect, are also constantly subject to fever as 
a result of an infection of the heart, indicates the necessity for a 
modification of their school curriculum, which must be provided 
through special classes. The physical strain induced by these chil- 
dren attempting to keep pace with normal children in regular 
classes is, therefore, not only an aggravation of their cardiac con- 
dition, but eventually prevents them from attending school. 

SCHOOL CARE 

This study of body temperature has been made the basis for 
the school care of severe cardiac cases admitted to these special 
classes in the public schools. A child with a temperature of 100° 
F. or more is not allowed to attend school. If the temperature is 
discovered after the child is in school, his class work is suspended 
and the child is permitted to rest in school for the remainder of 
the school day. He is not allowed to return to the class room until 
his temperature is normal. 

The name of the child and the degree of temperature should 
be reported at once by the teacher to the principal of the school. 



134 

The nurse associated with the cardiac clinic reports the condition 
to the parents and to the doctor in charge of the special cardiac 
clinic to which the child is attached, and arranges for the child to 
have care at home in bed until such time as he may be free from 
temperature for 24 hours, when he may return to school. 

The nurse in charge of the case calls upon the child daily at 
his home, and if he cannot have proper care at home, he is re- 
ferred, with the consent of his parents, for bed care at the hospi- 
tal affiliated with the special cardiac clinic. In case the child is ab- 
sent from school, the nurse investigates the cause of the first day's 
absence, in order that a record may be kept and treatment in- 
stituted. 

SCHOOL CURRICULUM 

From experimental observation it is apparent that certain 
modifications in the course of study are necessary to prevent strain 
and overwork. While it may not be necessary to change to any 
great extent the content of the various courses of study, it is es- 
sential that these children should be permitted to take a longer 
time to complete the same amount of work accomplished by 'nor- 
mal children. Even though their school life may be lengthened by 
this additional time, it will prevent worrying about examinations 
and similar causes of school strain. 

The curriculum should be so arranged as to include short 
morning periods of mental application, followed by rest or a quiet 
recreative period, and short periods of physical training adapted 
to the physical condition of each child. Furthermore, provision 
should be made in the afternoon periods for vocational training 
suitable to the strength and physical condition of the children, in 
order that they may become self-supporting in a measure after 
their school training has been completed. Many of these children 
will probably not live to adult life. This ability to do light indus- 
trial work would keep them happily engaged during the hours of 
enforced invalidism. 

ROUTINE SCHOOL DAY 

The following routine school day has been suggested for ex- 
perimental study: 



135 i 

TIME — ^ACTIVITIES 

8.30-9— Arrival. 

9-9.15 — Rest and reclining chairs. 

Observations to determine pulse rate, temperature and other 
physical conditions. 

9.15-10.15 — School program. 

*10.15-10.35 — Recess and recreative exercises. 

10.35-12.15 — School program. 

**12.15-12.45— Lunch period. 

12.45-1.45 — Rest period for all children in reclining chairs. 

1.45-3 — School program, including specialized physical train- 
ing exercises. These special exercises are for selected groups ar- 
ranged in accordance with the recommendations for physical ex- 
ercises provided by the cardiac specialist in charge of each child. 

AFTER SCHOOL RECREATION PERIOD 

3-3.15 — Rest in reclining chairs for observation to determine 
pulse rate, temperature and other physical conditions in relation 
to the amount of school work done during the school day and as a 
guide for after school recreation activities. 

3.15-4.15 — After school recreation period. Outdoor in pleas- 
ant weather. 

***4. 15-4.30 — Quiet games for all children. Hot drink in cold 
weather, or glass of milk and graham cracker before dismissal. 

* Note — It is suggested to omit mid-morning lunch in order that the 
parents may be encouraged to provide the children with a suitable break- 
fast before coming to school. It has been recommended that a period of 
about four to five hours should be observed between meals. 

** In connection with feeding in school there should be a proper cor- 
relation between the type and quantity of food supplied at that hour with 
the type and amount supplied at home. This should be accomplished 
through the co-operation of the Social Service Department of each car- 
diac clinic after consulting with the physician in charge. Suggestions to 
parents concerning proper diet should be made by the Social Service 
Nurse. 

***Note — It is a question whether it is advisable for these children 
to have any food between meals. Experiments have shown that 4 to 5 
hours' intermission between meals with no lunches during that time has 
given very satisfactory results. 



136 

4.45-5 — Walk home for exercise. Children unable to walk use 
trolley car or bus service where possible. Dismissal in winter at 
an earlier time, because of the shorter daylight hours. 

5.30 — Indoors. Dinner not later than 6. After dinner, quiet 
occupation. In bed before 7 o'clock. 

TENTATIVE PROGRAM SUGGESTED FOR SATURDAY AND SUNDAY 

In bed until 10 A. M. Co-operation should be encouraged in 
the home to keep the children in bed until 10 A. M., and then to 
continue the following program if possible. 
10-12 — Quiet recreation. 

12.00— Dinner. In bed until 2 P. M. 

Quiet play until 4.30. 

5 P. M. — At home. Dinner before 6. In bed before 7 P. M. 

CHART FOR GENERAL, OBSERVATION 

The following chart for use in cardiac clinics has been sug- 
gested for trial and further report by a committee of physicians 
in charge of these special clinics : 

1. Name 

2. Age 

3. Number of children in family 

4. Kind of control at home : Good : Fair : Poor : 

5. Number of times in bed or in hospital for heart conditions : 
Before observation After observation 

6. Approximate duration of disease in months or years 

7. Etiology : 

8. Diagnosis : 

*9. Hypertrophy or not 

10. Irregularity 

11. Average pulse rate at rest 

12. Pulse rate immediately after jumping with both feet 10 
times 

13. Pulse rate three minutes after having jumped with both 
feet 10 times 

14. Weight every week 

* By Hypertrophy we designate easily demonstrable enlargement of 
the heart. 



137 

15. Hsemoglobin taken once a month 

16. Lungs: Rales: Dullness: Dyspnea: 

17. Liver — palpable: not palpable: 

18. Spleen— palpable : not palpable: 

19. Morbidity — days absent from school during term 

1. Days in bed — cause of absence 

2. Days in sanitarium — cause of absence 

3. Days in hospital — cause of absence 

We thought it advisable that the children admitted to the car- 
diac classes should fit into Class III of the classification adopted 
by the Association of Cardiac Clinics, namely, "Patients with or- 
ganic heart disease at the time of observation who have symptoms 
of cardiac insufficiency following ordinary exertion." It might 
be preferred to have cases of mitral stenosis or aortic insufficiency 
given the preference, the class to consist only of girls. The class 
for experiment is to be limited to 25. 

RESULTS 

Certain definite results have been obtained through this experi- 
mental study which indicates that these special classes for cardi- 
opathic children have proved of great benefit. 

A study of the school attendance of various groups of cardiac 
cases showed, in general, a better record of attendance after 
segregation than at any previous period. The less severe cases 
whose records of attendance in regular classes were marked by 
long and frequent periods of absence, showed an attendance 
whereby the majority were able to complete the relaxed curricu- 
lum of the term while the more severe cases, who were unable to 
attend schools before segregation, showed good attendance and 
marked progress in their studies. 

The comparison of the attendance records of a group of car- 
diac cases shows a total of 492 days' absence before segregation 
and only 132 days after admission to a special class for one school 
year. Individual records are even more interesting. One child 
had a record of 89 days of absence during the school year, before 
admission to a special class, and but 12 days after admission; an- 
other child reduced his absences from 88 days to 24 and others 
showed a gain of 25 to 69 days. 



138 

An extremely interesting report has been made of the hospital 
record of the children associated with the cardiac clinic of the 
Lenox Hill Hospital. Last year, 20 children from this clinic re- 
quired treatment in the hospital for various periods. Since these 
children have been attending school in a special class for cardiacs 
with a supervised school day from 9.00 to 5.00, not one case has 
required hospital care other than two cases who contracted pneu- 
monia. 

Every child in this group of 25 in the special class at Public 
School 70 Annex, with the exception of one very serious congeni- 
tal case of heart disease, has gained in weight since segregation, 
some children gaining over a pound a month. 

Furthermore, the anxiety of the parents concerning the educa- 
tion of their children, was relieved, and the children themselves 
received not only mental and physical benefit through this special 
school, but also much pleasure. This is well illustrated by the re- 
mark of a little girl, who, after her first day at school, said: "This 
is the first time I have ever been in school. It is the happiest day 
of my life." 

RECOMM-ENDATIONS 

As a result of the experimental study for the special school 
care for cardiac cases, it is respectfully recommended 
that : 

1. Special classes for severe cardiac cases be formed in each 
cardiac clinic zone thfough the selective method herein 
outlined in co-operation with the treatment recommended 
by the cardiac specialists of these various clinics. 

2. Suitable classroom and personal equipment be provided 
for the classes now organized and for all additional spe- 
cial classes for cardiacs. 

3. Transportation be arranged for selected cases in each 
class. 



139 

CARDIAC CLASSES 
Louis Marks, Principal P. S. 64, Manhattan 

ORGANIZATION 

Because of several favorable conditions, the experiment of 
organizing the classes of cardiac children was tried at Public 
School 64, Manhattan, in the Children's Aid Society Building at 
8th Street and Avenue B. This is the center of a district ranging 
from 14th Street to Delancey Street, and from the river front to 
Third Avenue, making a hub of 17 schools in this area. 

Dr. Halsey of the Post-Graduate Hospital was in immediate 
charge of the examination of children for these classes, and was 
assisted by a staff of four associated physicians from the same 
hospital and two nurses from the Henry Street Settlement. The 
result of the examination showed about 150 children with heart 
disease. These children were classified according to the method 
adopted by the Association of Cardiac Clinics. Of these groups, 
I and n showed evidence of heart disease, but were without 
symptoms when examined. Group IV were children who had 
some finding on examination which was not of serious importance. 
Group III showed symptoms of heart weakness on slight or 
moderate exertions. It was only this group which was selected 
for the cardiac classes. 

The school had its formal opening on February 2, 1920, in the 
rooms of the Tompkins Square Building of the Children's Aid 
Society. Twenty-nine of the 77 Group III children were regis- 
tered. By February 27 there were 58. By the middle of March 
75 children were on register and thus the three classes were full. 

CLASSIFICATION 

Pupils who were classified as belonging to Groups I, II, IV, 
and a few of Group III who have remained in attendance in the 
regular classes of other schools of the district, are kept under ob- 
servation by means of a follow-up card. About 400 of these chil- 
dren are kept under supervision of the doctors. Once a month 
the nurse goes to the schools of the district, taking cards with her. 
The principal of each school has recorded on the card the number 
of school days of the month and the number of times absent of 



140 

each of these children. This insures close watching of each case. 
If any unusual symptom is noted, a re-examination of that child 
is made by the doctor. This record affords an opportunity for 
comparison between the children in the special cardiac classes and 
those in regular classes. 

The whole group of children are re-examined from time to 
time by Dr. Halsey and his associates to re-determine the condition 
of each child and what changes, if any, should be made in the 
treatment. The records and complete data concerning the physi- 
cal condition are carefully kept up to date, and there is a cross- 
index system. The principal of Public School 64 has the super- 
vision of the educational part of the program. 

At present the three classes at Public School 64 are graded as 
follows: Cardiac I — 25 children (boys and girls), lA to 3B; Car- 
diac II — 25 children (boys and girls), 4A to 6A; Cardiac III — 
25 children (boys and girls), 6B to 8A. There are three regular 
teachers in charge of these classes until 3 o'clock. At 3 P. M. 
three teachers of recreational activities take charge and remain 
with the children until 5 P. M. In fine weather an hour is spent 
in the park which is in front of the school. It is planned to in- 
troduce the elements of domestic science and manual training dur- 
ing the two hours before home-going. 



MOTHERS MEETINGS 

Once a month a mothers' meeting is held in the school so that 
the home may learn of the care and welfare of the children. The 
first meeting of this kind was held February 11, 1920, with 40 
mothers, two elder brothers and one father present. Mr. Marks 
and Dr. Halsey spoke concerning the educational and physical side 
of the work. Following the meeting they talked with the mothers 
individually. 

During the summer vacation some of the children will be sent 
to the country for rest and recreation. In addition to this there 
will be a summer vacation playground maintained under the De- 
partment of Recreational Activities. The Children's Aid Society 
will furnish a daily luncheon and a nurse. 



141 

THOROUGHNESS OF MAINTENANCE 

It may be of interest to note the exceptional thoroughness 
with which these classes are maintained. Every one of the 75 
children has received the Wassermann test besides the most care- 
ful re-examinations from time to time. Besides this, each child 
has received a careful individual intelligence test — the Terman, 
Sanford Revision of the |Binet Simon. 

Dr. Halsey hopes to make a final detailed report based upon his 
observations and statistical records. When this is completed it 
is certain that very definite conclusions will be drawn which will 
furnish a reliable contribution to the problem of cardiac children 
in our elementary schools. 



■ 142 

CARDIAC CLASSES 

Mrs. Henrietta Renaldo Scheider, Principal P. S. 75, Manhattan 

ORGANIZATION OF CLASSES 

Through the co-operation of the Board of Education with the 
Beth Israel Hospital, the Social Service Department of the hospi- 
tal and the Cardiac Clinic, there have been established two classes 
for children suffering with cardiac conditions. These children are 
considered too ill to attend the regular classes of the public 
schools, but not ill enough to be confined entirely to their homes. 

During the two years and a half since their organization, 28 
boys and 32 girls have been enrolled. During the same period 19 
boys and 26 girls have been discharged from the register. The 
causes for discharge are as follows : 

Condition improved, children recommended for return to 

regular grades 23 

Moved out of district 14 

Graduated 2 

Too ill to attend school 4 

Over school age 1 

Died 1 

45 

ENROLLMENT 

The present enrollment of 50 pupils in two classes shows 
children suffering from the following cardiac conditions : 

Boys Girls Total 

Aortic and mitral insufficiency 4 4 

Mitral insufficiency 8 23 31 

Double mitral insufficiency 1 5 6 

Stenosis 3 3 6 

Congenital 2 2 

Weakness, resultant from anemic condition 10 1 

19 31 50 

FOOD 

Good wholesome food and plenty of it is extremely important 
to keep up resistance to disease. It is useless to expect an under- 



143 

nourished patient to respond to medical treatment. To meet this 
need, the children are served with a hot luncheon at noon, and 
milk and bread and butter during the morning and afternoon ses- 
sions. A typical luncheon menu is as follows: A thick soup, 
either cereal or vegetable, meat and potatoes, bread and dessert, 
either stewed fruit or a nutritious pudding. 



PROGRAM 

During the summer months a roof school is conducted on the 
roof of the Beth Israel Hospital. Here the children rest and play 
trom nme to five. Nourishment is supplied by the hospital. In 
this way the children are kept ofif the street and under supervision. 
Girls improve more quickly than boys for the reason that girls are 
more easily controlled than boys and submit more readily to re- 
strictions. 

As the foregoing emphasis upon the physical care of cardiac 
children indicates, our aim is to regard the child first as a patient 
and then as a pupil. 



RESULTS 

The results obtained in two and a half years have justified the 
undertaking. All the children under treatment show an improved 
physical condition. They sleep better, eat more and with better 
appetite, and show an appreciable gain in weight. Their interest 
in school life has been re-awakened and they are making steady 
progress in their studies. Their attendance at school is more reg- 
ular. Eleven children who have been in the cardiac class for one 
term lost only 55 days by absence during this period. The same 
children lost 265 days by absence during the one term preceding 
their admission to the cardiac class. In other words there was 
an average gain of 19 days per child for one school term. These 
facts speak for themselves. 

The following table shows the gain in attendance of pupils 
in the two cardiac classes ; 



144 



Term Ending June 30, 1920 

Between Between Between Between 
1 term 1 and 2 2 and 3 3 and 4 4 and 5 
or less terms terms terms terms 

1. Number of pupils in car- 

diac classes 11 9 7 6 17 

2. Total number of days of 

absence of these pupils 
for equivalent periods in 
regular classes, preced- 
ing admission to special 
(cardiac class) 265 436 500 387 1533 

3. Total number of days of 

absence of these pupils 
from cardiac class with- 
in these periods 55 168 167 137 833 

4. Total number of days 

gained in attendance in 

cardiac class 210 268 333 250 700 

5. Average gain in attend- 

ance as pupils in cardiac 

class 19 30 48 42 41 



145 

CARDIAC CLASSES 
Abraham Smith, Principal Public School 70, Manhattan 

ORGANIZATION 

The class was organized on September 22, 1919. The pupils 
were drawn from nearby schools. The tentative register was 
made up by special recommendation from principals. Every child 
underwent a careful clinical examination at the hands of Dr. 
Bopp, Cardiac Specialist of Lenox Hill Hospital. Only children 
with marked organic lesions were accepted. 

Original register — -18. 

Present register — 24; 9 girls, 15 boys. 

CLINICS 

Clinics are held on Wednesdays and Fridays from 2 to 4 p. m. 
at the Lenox Hill Hospital. Each week every pupil is carefully 
examined as to his general condition and to the state of his heart. 
His progress is noted and recorded, and recommendations made 
for his future treatment. Records of every case are kept on spe- 
cial clinic cards. The child's general condition and progress de- 
termines the frequency of his visits to the clinic. Debilitated 
children are sent to the country to recuperate. Records of the 
temperature, pulse and respiration of the children are taken twice 
a day, and furnish a ready index to their cardiac condition. The 
deviation from the normal in these records shows the degree of 
acuteness of the cardiac malady. 



FOOD 

Twelve quarts of milk are sent to the class daily by the Board 
of Education Lunch Service. At 10 A. M. a light lunch is served 
consisting of a cup of milk and a graham cracker. Dinner is 
served at noon by the Lenox Hill Settlement for which a charge 
of five cents is made. The food is plain, wholesome and nutri- 
tious, and the Settlement deserves great credit for this most un- 
usual service. • 
10 



146 

REST PERIOD 

The children play a little after their noon meal, and then he 
down in the steamer chairs for 40 minutes. The room is well 
ventilated and darkened, and absolute quiet is observed. On the 
first occasion of using the chairs, eight children slept during most 
of the 40 minutes. The next day 16 out of the 19 present slept 
most of the time. 

RECREATION AFTER 3 P. M. 

The children stay daily till 4.30 in charge of special recreation 
teachers. They are divided in three groups according to their 
degree of health. They play either sitting games, quiet games or 
games of moderate activity, according to the group they are in. 
The main purpose of the recreation period is to keep the children 
off the streets where in emulation of physically normal children 
they might speedily undo the benefits of many weeks of careful 
treatment. 

CO-OPERATING AGENCIES 

The Lenox Hill Settlement, the Lenox Hill Hospital, with the 
affiliated Jacobi Hospital for Children, and its excellent Social 
Service Department, deserve a great deal of credit for their ef- 
fective co-operation in all work and experimentation. 



147 



SPEECH IMPROVEMENT 

Frederick Martin, Director 

The report of the progress of the Department of Speech Im- 
provement Progress during the year 1919-1920. 

Twenty-six teachers are now devoting their entire time to the 
work of speech improvement. Classes for the correction of speech 
defects, stammering, stuttermg, Hsping, acute defective phona- 
tion and acute foreign accent are conducted in 78 day elementary 
schools, in five evening schools and in five summer schools. This 
does not include all the work being- done, as there are also the 
clinics and the work of many teachers, trained at the clinics, who 
devote their spare periods to the correction of acute cases of 
speech defects in their schools. 

The work in the day elementary schools for the past year, con- 
sisting of stammering, stuttering, lisping, acute defective phona- 
tion and acute foreign accent, was conducted according to the fol- 
lowing schedules : 

MANHATTAN 

No. of Pupils Not 

Teacher Schools Classes Reg. Treated Cor. Impr.Impr. 

Dooling, A. M 9,17,94 120 4,145 212 101 111 

Dowd, J...110, 147, 188B, 188G 200 7,476 312 94 118 

Gavin, M 11,32,67 82 2,958 179 79 98 2 

Gilroy, M. C 43, 54, 157 138 6,097 192 78 109 5 

Gregory, G 5, lOB, lOP 151 6,127 224 10 212 2 

Gross, C 22, 88, 131 103 3,870 154 59 94 1 

Kiely, K 24,57,119 177 7,062 186 83 95 8 

McCord, E 51,58,84 107 3,870 223 97 126 

McNally,E.H. 87,93,141,165,179 182 7,211 375 192 183 

Moore, E. H 27, 40, 61 144 5,641 302 109 186 9 

O'Connor, A 20,83,109 178 6,700 288 148 140 

Pray, S 53,151,158 158 6,386 161 65 96 

Secor, M 2, 65, 114M 181 6,825 215 102 109 4 

Youmans, F 115 58 1,894 51 21 30 

BRONX 
Youmans, F 47,53 124 4,125 124 46 78 



148 

BROOKLYN 

Birmingham, A. I.. 35,93,149 172 6,884 184 55 122 7 

Douris, E. F 20B, 70, 179 136 5,111 248 156 88 4 

Dybynska, J Z2, 78, 29B 88 3,534 173 46 127 

Greene, E 25,79,162 111 4,492 116 39 67 5 

Murtha, L 13, 46, 58B 88 3,686 223 72> 150 1 

Prusslin, 1 168, 50, 166 100 4,966 166 81 77 10 

Seebeck, G 41,109 97 5,628 170 79 83 4 

QUEENS 

Farrell, E 20,21,23,31,41 66 2,434 188 87 101 

Milne, K 4,83,6 149 6,340 259 146 112 1 

Shelsey, C 11,92,89 92 3,380 462 211 238 13 

RICHMOND— NONE 

Pastel, E. — Recently from U. S. Army assigned to office. 
O'Conncll, C. — Recently from U. S. Army absent for health. 

The work in the Evening Schools is conducted according to the follow- 
ing schedule : 

Manhattan— 27. 32, 93, 103. 
Bronx — 54. 
The work in the Stimincr Schools is conducted according to the follow- 
ing schedule : 

Manhattan— 27, 186. 
Bronx — 54. 
Brooklyn— 50. 
Queens — 85. 
The work in the Clinics is conducted according to the following 
schedule : 

Manhattan— C. C. N. Y., Hunter College, 157 East 67th Street, 

Cornell Medical, Summer at C. C. N. Y. 
Brooklyn — Brooklyn Training School. 
Queens — Bryant High School, Jamaica T. S. 

These clinics have been conducted without any additional ex- 
pense to the city because the teachers have volunteered their ser- 
vices without compensation. 

As director I have supervised the 26 teachers of the speech 
improvement by visiting the schools and observing the work of 
the teachers ; by observing and criticising the work of the teachers 
in the clinics ; by verifying cards sent to the ofifice by the teachers 
for cases under instruction. 



149 

The speech improvement work done by the speech improve- 
ment teachers has been of infinite value in the correction of sUght 
cases and as a preventive measure. The foreign accent syllabus 
has proven to be a practical aid for both class teacher and speech 
improvement teacher. 

The speech improvement work is essential as follow-up work 
for cases of stammering and lisping corrected in special groups. 
This follow-up work has been planned according to two divi- 
sions : the work done as a result of conference by class teacher 
and speech improvement teacher ; the work done as a result of 
conference of parents and speech improvement teachers. 

The teachers of speech improvement have co-operated with 
principals and class teachers of their schools by holding confer- 
ences ; by devoting auxiliary periods to assisting teachers with dif- 
ficult cases ; by visiting classes and giving desired assistance to 
class teachers ; by conferring with teachers in regard to follow- 
up work for pupils in speech correction classes ; by holding dis- 
trict conferences. 

ARMY WORK 

Three of the specially trained teachers in our clinics — Cather- 
ine V. O'Connell, Esta V. Pastel and Mary K. Thornton, have 
devoted 18 months to army work. They were selected by the sur- 
geon-general of the United States Army to organize the work of 
the correction of speech defects in soldiers who have suffered im- 
pairment of speech organs or suffered from "shell-shock." Their 
work has been highly praised by Colonel Richardson and Lieu- 
tenant-Colonel Blair of the reconstruction units. 

SYLLABUS ON FOREIGN ACCENT 

In connection with the present movement for the Americaniza- 
tion of the foreigner, many cities are now employing the syllabus 
on foreign accent, prepared by this department and adopted by the 
Board of Superintendents. This pamphlet is not only intended 
as a definite manual for the correction of foreign accent, so preva- 
lent in some sections of our city, but it is also a guide to the teach- 
ers in correcting general imperfect phonation. If the drills and 
vocal gymnastics contained in this pamphlet are practised daily. 



150 

in conjunction with the "two-minute setting-up drills," an ap- 
preciable improvement in the pupils' voices will soon be noted and 
a marked change in their articulation. 

RECOMMENDATION 

A central school in each borough, where acute cases of stam- 
mering may be isolated from all other students, should be selected. 
This will give the sufiferer the opportunity and incentive to devote 
a very considerable portion of his time to a study of his speech. 
Cases would be kept here for periods varying from a month to a 
year, until entirely corrected. 



151 



PARENTAL AND BROOKLYN TRUANT SCHOOLS 

John S. Fitzpatrick, Principal 

BUILDINGS 

The New York Parental School is located in Flushing on a 
farm of 107 acres. There are at present five building's, three dou- 
ble cottages provide accommodations for 216 boys. The power 
house contains the light, the heat and the ice plants, the bakery, 
the kitchen and the laundry. In the administration building are 
six classrooms, the auditorium, the gymnasium and the following 
shops : shoe, printing, plumbing, carpenter, tailor and wood work- 
ing. The latter building and the power house are connected by a 
subway, through which entrance is obtained to each cottage. 
Through the subway the meals are conveyed by means of trucks 
carrying thermos utensils. 

At the Brooklyn Truant School, Jamaica Avenue and Enfield 
Street, there are about 14 acres of land. The buildings are old 
and beyond repair. The buildings and the equipment are unsuited 
to the care of truants. 

PHYSICAL AND MEDICAL EXAMINATION 

The day the boy enters the school he is given a thorough phys- 
ical examination, first by the resident school nurse and then by 
the visiting physician. A careful record is kept of the physical 
condition of each boy. If necessary a course of treatment is pre- 
scribed, special attention being given to diet, medication, physical 
training and out-door life. Minor operations are performed when 
necessary at the local hospitals, and boys are also treated there for 
eye and teeth trouble. 

The proof of the physical fitness of the boys was manifest dur- 
ing the last two epidemics of influenza which visited every part 
of the United States. Owing to the previous clean, regular living 
and rigid quarantine at once established at the outbreak, not one 
boy in the Parental or the Brooklyn Truant School developed in- 
fluenza. 



152 



DAILY LIFE 



The daily life of the boys at the Parental School is one of in- 
tense activity. The bugle sounds reveille at 6 A. M. In 20 min- 
utes every boy has had a shower bath and is ready for the day's 
work. Breakfast is served at 7.00. From 7.45 the boys enjoy free 
play until the call to assemble for military drill on the campus at 
8.15. After drill the boys fall-in to march to school and shops. 
From 9 A. M. until 4 P. M., excepting the dinner interim, 12 to 1, 
they are divided into alternating groups, A and B. A group is in 
the classrooms three hours in the morning and B group in the 
shops and vice-versa in the afternoon. 

GRADE WORK 

Truants are committed from many different schools in the five 
boroughs. They are admitted to the same grade they attended in 
the elementary school. The pupils are grouped by each class by 
subjects, and in each subject according to ability. The teachers 
ascertain the knowledge each boy has in each subject and this 
knowledge is used as the basis of the new work. One of the chief 
aims of the schools is to have the boy feel that he is among those 
who understand him and are trying to teach and help him to have 
confidence in his own ability. Having once established this condi- 
tion, the teacher is able to inculcate new habits, namely, appli- 
cation, industry, honesty, politeness and obedience. At first they 
are given work they are well able to do, so they gradually become 
interested and apply themselves and their progress is marked. 
The school as a whole is grouped as follows : 

(a) Pupils who,- when paroled, are to return to the elementary schools. 

(b) Pupils eligible for emplojanent certificates. 

(c) Pupils over age and below grade. 

(d) Pupils who may graduate. 

The grade work is also planned to meet the above conditions. 

Forty-three boys were graduated from' the Parental School 
since September, 1917. Regular elementary school diplomas were 
accorded and the boys are designated as graduates of Public 
School 70, Queens. 



153 

ACTIVITIES AND PRODUCTS 
PRINTING 

Upper grade boys are assigned to- the printing shop in two 
groups of 12 to 15 boys each. The boys and one instructor do 
from $3,000 to $5,600 worth of work each year for the Board of 
Education. The printing class is noted for the excellent quality 
of the work done and the promptness with which orders are filled. 

THE BAND 

The reputation of the band rivals that of the printing class. 
The band is self-supporting". During the past three years it has 
furnished music for Liberty Loan drives, the Red Cross, draft 
send-ofifs, welcome home receptions and the June festivals of the 
public school kindergartens. 

From both the printing class and the band, boys are assured 
of good positions. 

THE TAILOR SHOP 

Winter and summer uniforms, gray and olive drab respective- 
ly, are supplied for use in the Parental School. The uniforms are 
made by the school tailor, assisted by assigned boys. In the shop 
boys are taught to mend and care for their outer garments. 

THE SHOE SHOP 

The work done in the shoe shop is of great value ; not only 
does it teach the boys a useful and economic trade, but shoes which 
have apparently gone beyond repair are torn apart, the worn parts 
thrown aside, good pieces substituted, and very good shoes finally 
derived. 

WOODWORK 

The value of manual training is exemplified by the interest and 
proficiency shown by the boys in the manufacture of models for 
furniture, household implements, toys, airplanes, etc. 

REPAIRS 

Most of the repairs in and about the building are done by the 
plumber and the carpenter, assisted by selected groups of boys. 



154 



THE LAUNDRY 

All the laundry work for the Parental, the Brooklyn and the 
Manhattan Truant Schools, the Board of Education and several 
departments is done at the Parental School. 

THE BAKERY 

The Parental School bakery not only makes its own bread and 
pastry, but also supplies the Brooklyn and the Manhattan Truant 
Schools. 

THE FARM 

Sixty-five acres of the school property are cultivated. Enough 
vegetables are raised to feed the employees and the boys at the 
Parental and the Manhattan Truant Schools throughout the year. 
All the boys participate in some form of farm work under the 
supervision of experienced farmers. The anemic type of boy is 
assigned permanently to farming of the lighter kind during his 
commitment. The plentiful supply of fresh green vegetables in 
their diet aids materially in the physical upbuilding of the boys. 

PHYSICAL TRAINING 

During the past two years there has been a resident physical 
training instructor at the Parental School which accounts for the 
manifest improvement in the carriage, posture and general health 
of the boys. The work consists of military training, formal gym- 
nastics, athletics, free play and organized games. Selected boys 
are drilled for exhibition work for assemblies and entertainments. 
A World Meet is held each year. Inter-cottage series are played in 
baseball, basketball and hockey. Baseball and basketball games 
are played with teams from local elementary schools. 

LECTURES 

Lectures, motion pictures and entertainments are given Sat- 
urday evenings. Plays are loaned by the leading film companies. 

RELIGION 

Representatives of the local Jewish. Catholic and Protestant 
religions visit the schools regularly to instruct the boys of their 
respective denominations. 



ISS 



THE BROOKLYN TRUANT SCHOOL 



The younger truants are sent to the Brooklyn school. They 
attend school five hours daily. The classes are small and the 
grade work is excellent. The manual activities are limited due 
to the equipment. The boys receive instruction in woodworking 
and basketry. Small groups of boys help on the farm and on 
the lawns. Special attention is given to physical training. 

Since April, 1917, the Brooklyn Truant School has been in 
charge of Mr. W.-Tully Bascom, who has rendered excellent ser- 
vice. 

RECOMMENDATIONS 

1. That the Brooklyn Truant School be closed and the prop- 
erty turned back to the city. 

2. That money should be appropriated and the contracts 
awarded for the erection of the following buildings at 
the Parental School for which plans have already been 
drawn: cottages to accommodate 300 boys, a home for 
the principal whose apartments now occupy much needed 
space in the administration building, an infirmary, a barn, 
a hog pen and a hennery. 

3. That boys should be kept in the Parental School at least 
eight months. 

4. That the following boys should be sent to the Parental 
School : 

(a) All truants in the seventh and eighth grades. 

(b) All truants fourteen years old and older. 

(c) All candidates for employment certificates. 

5. That the following boys should not be sent to the 
Parental School: 

(a) All truants under twelve years old. 

(b) All truants below the 5A grade. 

6. That the minimum commitment age to any truant school 
should be nine years. 

The following tabulation shows the boroughs and the number 
of the different schools from which the 220 boys in the New York 
Parental School and the 120 boys in the Brooklyn Truant School, 
June 30, 1919, were received : 



156 



Parental School 
Borough No. of Schools 

Manhattan 47 

The Bronx 13 

Brooklyn 54 

Queens 10 

Private 9 

Brooklyn Truant 

Manhattan 28 

The Bronx 7 

Brooklyn 41 

Queens 7 

Private 4 



No. of Boys 
82 
21 
89 
19 
9 



49 
7 

49 

10 

5 



COMMITMENTS 

The number of truants committed to (1) the New York Par- 
ental School, (2) the Brooklyn Truant School, during the school 
years 1918-19 and 1919-20, is shown by the following table : 



Number of children in school, 
July 1 

Number first committed di- 
rectly, between July and 
June 30: 

By director. Bureau of 

Attendance 

By Court 22 

Number returned on broken 
parole from July 1 to 
June 30 

Number returned from other 
truant" schools 

Number returned from hos- 
pitals 

Total number received.. 
Number paroles from July 1 

to June 30 

Number discharged from July 

1 to June 30 

Number transferred to other 

schools 



(1) 



1918-19 
214 



1919-20 
207 



(2) 
1918-19 1919-20 



132 



116 



173 


246 


123 


136 


■195 


15—261 


16—139 


12—148 


34 


7i 


63 


43 


171 


130 


103 


51 


20 


5 


1 


1 


634 


676 


438 


359 


269 


336 


198 


184 


71 


53 


32 


12 


58 


56 


71 


38 



207 


229 


11 


6 


12 


12 


206 


215 



?18-1S 


(2) 

• 1919-20 


20 







1 




5 


322 
116 




239 
120 



157 

(1) 

1918-19 1919-20 

Number transferred to N. Y. 

Catholic Protectory 7 7 

Number transferred to hos- 
pitals 22 6 

Total 

Number on register July 1 . . 
Number graduated, January. 
Number graduated, June.... 
Average daily attendance. . 206 215 118 119 

Value of the Productions 

1918 1919 

Laundry $13,782.87 $20,277.61 

Bakery 12,970.68 14,249.75 

Farm 8,648.84 9,211.26 

Tailor 2,000.00 2,344.00 

Plumbing 656.40 1,033.85 

Printing 5,601.75 4,605.25 

Carpenter 1,794.25 1,684.83 

Shoe Shop 2,054.43 2,086.05 

Ice Plant 2,500.00 

Engineer .' 600,00 650.00 



Total $48,109.22 $58,642.60 



158 

MANHATTAN TRUANT SCHOOL 
Mary K. Leonard, Matron -Superintendent 

The activities of the Manhattan Truant School, which is of 
mixed grades, are divided into common branches, grades lA 
through 6B, shop work and physical training. 

The subjects taught in common branches embrace arithmetic, 
history, reading, spelHng, grammar, composition, Hterature, pen- 
manship and geography, two teachers dividing these subjects be- 
tween them. 

In the shop, under the direction of one teacher, the following 
articles are made by the boys, viz. : Morris chairs, tabourettes, 
knife boxes, letter boxes, picture frames, pen trays, bread boards, 
sleeve boards, etc. In addition, basketry, chair caning, free hand 
drawing, lettering, sketching and sign painting are taught. 

One hour and a half daily is given to physical training with 
apparatus work and military drill, this under the supervision of 
a physical training teacher. 

Physical examinations are conducted at various intervals. We 
aim to make the health, cleanliness and hygiene of the children im- 
portant factors in their care, and we have been fortunate during 
the year 1919-1920 in having no cases of illness in the school. The 
number of admissions during the period July 1, 1919, to May 31, 
1920, were 316 boys. The maximum capacity of the school at 
any one time, however, is only about 50 or 52. The commitment 
of a boy for violation of the Compulsory Education law is for two 
years, but the duration of his stay at this school is usually limited 
to five months, after which he is paroled, provided his conduct 
and progress warrants it. 



159 



REPORT ON PROpATIONA*RY SCHOOLS 

1918-1819-1920 

P. S. 120, Manhattan, Olive M. Jones, Principal 

P. S. 61, Brooklyn, Lucille Nicol, Teacher-in-Charge 

P. S. iT 1 Manhattan, Hazen Chatfield, Teacher-in-Charge 

ORGANIZATION 

The probationary schools are organized for the purpose of 
taking care of truants, deHnquents, over age and backward pupils 
as v^ell as those who, for some special reason, the principals or 
district superintendents consider are in need of special help. 

Public School 120, Manhattan, and Public School 61, Brook- 
lyn, admit about 300 boys within a year. Public School VJ , Man- 
hattan, was organized February 5, 1919, and it is impossible to 
say how many boys it can accommodate annually. When the 
school was organized six teachers were appointed, and boys were 
transferred from other schools by special order of the district su- 
perintendent. They were admitted a few at a time, so that each 
one might be tested and his needs studied. Retarded boys were 
given every opportunity to catch up in their grade work. 

Public School 120, Manhattan, takes boys from the district 
below 14th Street. Public School 61, Brooklyn, takes boys from 
nine districts and 69 schools. Public School 37, Manhattan, takes 
boys from Districts 10 and 11. 

One of the difficulties of these schools are the constant 
changes — admissions and discharges occurring daily. Discharges 
are usually given for the following reasons : 

Labor certificates. 

Over age. 

Returned to schools. 

Committed to institutions. 

Physically incapacitated (very few). 

Out of city (removal). 

Suspense list (boys who run away and cannot be located by Bureau 

of Attendance). 
Graduates. 

In reference to the above, Miss Jones, Public School 120, re- 
ports that the two years, 1918-1920, have been unquestionably the 



160 

most difficult years in the history of the school. The number of 
applications for admission has been greater than ever before, and 
the boys have been harder to manage. They presented many new 
and more difficult problems than even those we had to face in 
the first years of the school. The parents were even more difficult 
than the children to deal with, and in very few instances did the 
parents give willing co-operation except in cases where the boys 
had been in school for a long time. The ease with which boys 
obtained employment and the unusual sums of money they could 
earn made the task of keeping them in school almost impossible. 

Another difficulty which complicated the problem in Public 
School 120, was the discontinuance of the evening session. It was 
impossible to find additional teachers to do this work, and ex- 
perience has demonstrated that the teachers serving during the 
day cannot successfully do the evening work as well. In conse- 
quence, we lost our hold on the boys at night. In previous years 
they had been accustomed to coming to the school tO' read, study, 
work up in the subjects in which they were backward, and play. 
Lacking this opportunity, they went to the moving picture houses, 
to poolrooms, and became the prey of gangsters of whom there 
has been recently a larger number than in a number of years be- 
fore in this neighborhood. 

Miss Nicol, Public School 61, reports that during the time 
covered by this report. 27 boys graduated. Of these graduates, 
12 were discharged and went to work; 15 entered junior high 
school, vocational school or high school ; seven are still there, the 
other eight having left and gone to work. 

The number of boys sent to institutions from Public School 61 
has shown a decrease each year, although the register of the 
school has shown an increase. In 1918 (the year of the war) 
21 boys out of 213 (9 per cent) were committed to corrective in- 
stitutions. In 1919, out of 305 boys, only 10 (3 per cent) had to 
be committed to institutions. September, 1919. to date, eight 
boys out of 286, 29 (10 per cent) had to be sent away. Since 
most of the boys sent here are "on their way to institutions" we 
note with pride the decrease. 

It is clearly evident that laws are badly needed fixing the re- 
sponsibility of the parent. The desire to shift responsibility and 



161 

get rid of the boy until he is able to earn his own living should 
be more carefully investigated. In the desire to "make money,'' 
especially since the war, children are given little or no super- 
vision. 

CAUSES OF TRUANCY AND DELINQUENCY 

From a careful study made of causes of truancy and delin- 
quency in Public School 61, through the reports of the visiting 
teacher, the following facts have been gathered : 

Causes — Lack of parental control, 45 per cent; incorrigibility, 
3 per cent ; truancy, 7 per cent ; over age and unwilling to be in 
class with younger boys, 9 per cent; frequent change of residence 
and school, 12 per cent ; hoys whose principals claim are motor- 
minded and who need special individual attention, 3 per cent. 
These causes overlap and it is difficult to make a line of demarca- 
tion. Sometimes several causes apply to the same case. Where 
truancy and incorrigibility have been cited as causes, it refers to 
cases where parents have co-operated with us and failed. The 21 
per cent delinquency is largely due to lack of parental control and 
bad associates. 

A study of nationalities in Public School 61 shows the follow- 
ing : 

Russian, Polish (Jewish) .58 per cent; Italian, 24 per cent ; 
colored, .06 per cent ; American, .039 per cent ; German, .037 per 
cent; Irish, .02 per cent; Polish (Catholics), .015 per cent; 
French, .006 per cent. 

Public School 120 reports that 83 per cent of the boys need 
physical care. The difficulty is not with the securing of the ex- 
aminations or the diagnoses. The trouble is in securing the care 
and treatment after diagnosis is made. Furthermore, the physical 
care should be given years before there is any question of the 
boy's physical condition upon his work in school, his securing of 
an employment certificate or his success in employment. One of 
the greatest needs for probationary school work is the enactment 
of some law making compulsory upon the parent the consent to 
necessary medical care and of some law making provision for the 
school to secure such care. 

11 



162 

PHYSICAL DEFECTS HEALTH HYGIENE 

In Public School 37, Manhattan, by special arrangement with 
the Board of Health, Dr. Hyams made a careful physical exam- 
ination of each entrant. The summary follows : 

DEFECTS 

General defects 130 boys 

Vision 55 

Hearing 13 

Nasal breathing 29 

Hyp. tonsils 29 

Malnutrition 89 

Cardiac 10 

Orthopedic 7 

. Nervous diseases 5 

Defective teeth 109 

Total number of defects 346 

Total number examined 216 

The foregoing tabulation reveals an appalling degree of physi- 
cal deterioration. It is quite obvious that these various ailments 
furnish an excuse for absence if not a real reason for truancy. 
Poor vision, malnutrition and defective teeth are positive handi- 
caps which account for retardation, irritability and bad conduct. 
These defects can only be remedied with the greatest difficulty. 
The boys are ashamed to wear glasses, they choose their own food 
and they fear the dentist. Little is accomplished by appeals to 
the home. In most cases the boys defy their parents, and are 
more obedient in school than out of it. Parents have no time to 
take their children to after-school clinics. When sent alone the 
boys often get into trouble and are kept waiting until the last. 
Whenever there is assurance that a boy will follow directions he 
is given a pass to visit the clinic during school hours. At times 
it has been necessary to send a teacher with them or escort them 
in person. 

Public School 61 reports that the self-respect of the boys has 
been increased by the emphasis placed upon personal cleanliness. 
A system of daily inspection has been introduced with ratings, 
and the boys show a decided improvement. Clean faces and 
hands, clean shirtwaists, neckties and polished shoes have given 
the boys a changed appearance. 



163 




164 

The school nurse reports that every boy in the school has been 
examined by the doctor upon his first visit after the admission 
of the boy. With very few exceptions, those suffering from hy- 
pertrophied tonsils, adenoids, eye, ear or nasal defects and de- 
fective teeth are either under treatment or have had their defects 
remedied. A dentist (a member of the Local School Board) has 
given our boys in very needy cases prompt and effective treat- 
ment. 

The teacher of physical training reports an average gain in 
height of two and three-cjuarter inches, an increase in weight of 
approximately five pounds, and an improvement in posture of 
30 per cent. 

SCHOOL LUNCH 

Another problem with which the probationary schools have to 
contend is the lunch problem. The boys in these schools usually 
live too far away to permit them tO' go home to lunch. No boys 
in Public School 120 or Public School 61 go home at noon, and 
only a few in Public School Z7 . 

Each school handles the problem to meet its individual needs. 
In Public School 120 the lunch problem has been carried on in 
four ways: (1) By a teacher sent by the director of cooking, 
giving the boys helpfully illustrated talks on food value. (2) 
By the teacher in charge of the physical training in the school 
who measured and weighed the boys and led them to see the re- 
lation between their physical condition and their eating habits. 
(3) By the teachers in charge of the lunch service, who co-op- 
erated with the two teachers just mentioned, supervised the quan- 
tity and kind of food and induced the boys to eat more nutritive 
food. (4) Communications to parents in regard to needs of the 
boys. The teachers report a greatly increased demand for foods 
containing milk and clear milk foods which they would scarcely 
touch previously. 

In Public School 61 a canteen run by the boys was inaugurated 
in September, 1918. The boys have developed splendid business 
ability. They not only sell the things, but buy the supplies. They 
furnish, at a nominal cost, milk, cocoa (in cold weather), fruit in 
season, crackers, sandwiches (tongue, ham, corned beef, cheese). 
Theyjcook the ham and tongue theniselves. The following things 



165 

are cooked and prepared by the boys : Soup, buckwheat cakes, 
pancakes, beans, apple fritters, banana fritters, frankfurters, 
spaghetti, French toast, stewed prunes, apricots, etc. Candy is 
no longer sold. There is no demand for it. Cooked fruits seem 
to take its place. The menu changes daily. 

Each boy who joins the canteen (those who run it) invests 
$1.50. The average sales have increased from $4.50 per day to 
$7.75. Dividends are paid at the end of each term. The boys 
keep account of their expenses and income and receive much 
practical training in cooking and business methods. They have 
bought their own cooking utensils, furnished a new table with 
iron stands, and presented a set of silk Allied flags to the school. 

In Public School 7)7 a lunch service was inaugurated in Decem- 
ber, 1919, to provide those boys who live at a distance of ten 
blocks or more and to make an attempt to reduce malnutrition. 
Hot cocoa and crackers were served to each boy who was able to 
pay 5c. for them. A seat at the table was also provided for each 
boy who brought his own lunch. In March, through the co-opera- 
tion of the Park Community Council, the serving of regular 
lunches was begun. Soup or cocoa, sandwiches and dessert are 
furnished daily for 10c. per person. From 50 to 100 boys avail 
themselves daily of this privilege. Parents of underfed boys were 
urged to pay 50c. per week for tickets. The results are encourag- 
ing. The chairman of the Food Committee of the Park Com- 
munity Council, purchases all food, hires and pays the cook, and 
aids in preparing the lunches. A teacher sells the tickets, super- 
vises the setting of the tables, and looks after the school property. 
The lunch service is not self-sustaining. 

SCHOOL BANK 

Public School 61 has a school bank, the report of which is 
as follows : 

The bank was organized December 7, 1916. 

Amount deposited since organization $595.18 

Amount deposited September, 1919, to date 125.21 

Balance in bank 154.29 

There are 134 active accounts. The books, drafts, and all 
material for the bank are printed by the boys. The accounts are 
kept by the boys. 



166 

GARDEN 

Public School 61 has a garden in a vacant lot adjoining the 
school but not school property. It has been in operation five years. 
In the spring of 1919 peas were planted and in a year when peas 
failed the crop was 68 quarts. During the summer of 1919 the 
garden was kept up. It was considered one of the best gardens in 
Broolclyn and was visited until November. The crop yielded 
132 quarts of beans, 20 bunches of radishes, 200 ears of corn. 
The boys also took care of the lawn. Asters were planted and 
added much to the appearance of the school. The garden will 
be continued this spring and through the summer. 

AFTERNOON RECREATION CENTERS 

Each of the schools has an afternoon recreation center. The 
one in Public School Z7 was discontinued owing to the small 
attendance. This was due to the fact that so many boys work 
after school and live at a distance from the school. In Public 
School 61 the attendance of the boys was not variable, as many 
of them worked, but as it was the only center, boys from neigh- 
boring schools came in and thus increased the attendance and 
interest. 

There is every reason to believe that these boys are subjected 
to unusual temptations after school hours — smoking, gambling, 
and illegal employment, and that competitive games would be 
helpful. It is a difficult problem as attendance is not compulsory. 

S. p. C. C. ANNEX 

The institutional classes in S. P. C. C. are an annex to Public 
School ZT . There are five classes. The rooms are small, the 
registers fluctuate, organized class instruction is carried on with 
great difficulty. In June, 1919, the roof playground was in use 
under the direction of an afternoon recreation center teacher. 
The girls had two afternoons a week, boys three. Funds for this 
were denied in 1920. Inasmuch as these children are denied their 
freedom twenty-four hours a day, it is not unreasonable to de- 
mand that they be given every opportunity to play in the open 
air. Since organized play is necessary for their protection and 
safety on a crowded roof playground a trained recreation center 
teacher should be put at their disposal every afternoon. 



167 



SHOP WORK 



Shop work is carried on in all three schools. Public School 
120 and Public School 61 each have one shop, while Public School 
Zy has two. The difficulty encountered is to furnish varied 
models within the intelligence of these boys. The older boys 
make furniture and articles for use in their homes. 

Manual training is quite a feature in Public School 61 where 
it is co-ordinated with the work of the shop and drawing and 
design. This work is practically self-supporting as most of the 
things made in it are made to order, the boys furnishing the labor 
and the people interested in the school, the materials. This has 
given the boys practical, business training in that the boys not 
only made the things but delivered them, made out bills, receipted 
these and filed the receipts for delivery. 

The principal's office has been fitted by the boys with settees, 
copper book ends, letter rack and pen tray, runners (stencilled) 
screens, couch cover, costumer, umbrella stand. 

The activities include upholstery, bead work, metal work, weav- 
ing, cobbling, book binding, tray making, reed and raffia, cretonne 
novelties, etc., etc., stencilling, sign printing and poster making. 

The drawing and design has been more practical than ever. 
Tin cracker boxes from the canteen (not returnable) were 
painted with designs and made fine cake boxes. Designs were 
made for book ends. Stencils were made for curtains and run- 
ners and signs and posters made for fairs and neighborhood 
events. 

Public School 120 made a number of articles for the Red Cross 
and for former pupils of the school in the Army and Navy. The 
usual Christmas gifts were made and sent to Beth Israel Hospital 
and Gouverneur Hospital. 

PRINTING 

Public School 61 has a small printing press, the gift of one of 
the teachers. On this the boys have printed programs for the 
schools in the neighborhood and for various club affairs, tickets, 
small booklets and pamphlets, and various circulars for associa- 
tions. In addition to this the boys have printed all the cards for 
use in the school and various things for the district superinten- 



168 

dent. During the past two years 242 jobs have been turned out 
on the press. 

Public School yj has the press and printing equipment for- 
merly in Public School 30, the Bronx. It has been in use since 
December, but the press, which is made to run by motor, has not 
yet been completely installed. It cannot be used. 

SHEET METAL SHOP 

Public School Z7 is equipped with a sheet metal shop. It has 
been in operation since November. Up to the present time the 
gas stoves have not been connected. A temporary arrangement 
had to be made. 

BUSINESS METHODS 

A brief course designed to prepare the boys for work is in 
every school. Public School })7 has typewriters for this course. 

In Public School 120 this was begun in 1909. It was designed 
to fit the boy for his first "job" and make possible his advance- 
ment. Poster making and sign printing are included. The signs 
are used in the neighborhood by small stores and push cart 
workers. 

In Public School 61 it is used to supplement arithmetic and 
English and includes sign printing, business letters, bills, receipts, 
checks, inventories, money orders, telegrams, etc. 

The canteen and bank add much to the practicality of the work 
in Public School 61. Here, too, the boys are receiving, checking, 
and distributing supplies as part of this training. 10,000 circulars 
and 50,000 booklets and circulars were folded and placed in en- 
velopes for E. N. Y. Savings Bank. This community service 
is helpful in gaining the respect of the neighborhood for the 
school. 

ACADEMIC SUBJECTS 

English, arithmetic, history, geography, civics, etc., are also 
included in the curriculum; arithmetic is a very difficult subject 
for these boys. History and civics are featured because of the 
need for it with boys who have little respect for law and order. 

The teaching of history in Public School 61 has been made 
more interesting by means of a radiopticon. This was purchased 
from the Wertheim $100 prize which was won for selling W. S. S. 



169 

The boys also subscribe to Current Events. The radiopticon also 
proves of value in geography, as well as the Geographic News 
Bulletin which we receive monthly from Washington. The boys 
compete for a history medal yearly, the Daughters of the Revolu- 
tion giving the topic. 

Civics was especially emphasized in Public School 120 by 
assembly talks by the principal and invited guests, in addition to 
extra time given to it by every teacher. 

PHYSICAL TRAINING 

Special attention is given to this in all the schools for the train- 
ing in attention, inhibition and response. Many of these boys do 
not know how to play a fair game. This training is essential and 
is of great moral value in a school of this type. 

VISITING TEACHER 

Public School 61 has a visiting teacher furnished by the Alli- 
ance of Women's Clubs of Brooklyn. She has proved very help- 
ful in reporting home conditions, getting help when necessary 
and following up the boys after they leave. 

SUGGESTIONS 

The buildings in which the probationary schools are located 
are all old and unsanitary. Public School 120 is the poorest of 
the three. This school needs additional shops and gymnasium 
space, and either a new and enlarged building or an addition 
built to the present building. 

Public School 61 is handicapped by the size of the building. 
The printing press which was sent from Public School 23 is still 
there as funds for its removal are not available. Typewriters are 
needed for the business course. The report from that school 
asks for a more liberal supply of funds for supplies. Psycho- 
logical tests would prove very helpful but the prices are pro- 
hibitive with the present allotment of money. 

Public School 37 requests shower baths. A request is made 
here also for individual psychological tests. 

Every boy admitted to these schools should be examined physi- 
cally and mentally. It is only in this way that the problem can 
be intelligently attacked. 



170 
VISITING TEACHERS 

FUNCTION AND REQUIREMENTS 

An interpreter has to understand two languages ; so the visit- 
ing teacher, with her two-fold function of interpreting the school 
to the home and the home to the school must have had the train- 
ing and experience of both teacher and social worker. Having 
met the classroom problem, she is able to explain to the parent 
the child's school difficulties. Through her experience- in social 
work, she is able to grasp and adjust the needs of the home. Thus 
she brings about the double co-operation of the home and school 
for the benefit of the child. The requirements for visiting teachers 
are: 

Either (a) (1) Graduation from high school or an equivalent education, 
and five years' experience as visiting teacher approved by the 
Board of Examiners, or 

(b) (1) Graduation from an approved college, or from an ap- 
proved normal or training school, and (2) at least one year of 
successful experience in teaching, and (3) one year of pro- 
fessional training in social work including case work satisfac- 
tory to the Board of Examiners, or two years of experience 
as visiting teacher under supervision approved by the Board 
of Examiners, or two years of social case work under super- 
vision approved by the Board of Examiners. 

These requirements represent a minimum only. Many cases 
of children and parents present problems of mental maladjust- 
ment, so that it is highly desirable, if not indispensable, that the 
visiting teacher have some understanding of psychiatry or psycho- 
analysis. Abundant tact, child study, and knowledge of human 
nature will contribue largely to her success. 

ASSIGNMENT AND SUPERVISION 

Each visiting teacher is under the supervision of a district 
superintendent, who assigns her to schools in his districts. The 
six visiting teachers are assigned as follows : 



171 



Jessie L. Louderback to P. S. 15, 36, 61, 64, 188G, Manhattan. 
Margaret A. McGroarty to P. S. 78, 102, 159, Manhattan. 
Kathryne E. Manley to P. S. 109, 149, 165, 173, Brooklyn. 
Dorothy Brown Knote to P. S. 40, 60, 82, 124, 172, Brooklyn. 
Cornelia L. Swinnerton to P. S. 3, 30, 43, The Bronx. 
Christine Schaefer (resigned Dec, 1919) to P. S. 5, 32, 45, The 
Bronx. 

Former teachers of German assigned temporarily as visiting 
teachers. 

Flora Goos to P. S. 18, 27, 59, Manhattan. 
Pauline G. Margolies to P. S. 30, 109, 121, 150, 151, Manhattan. 
Emilie Nida to schools in Districts 8 and 13, Manhattan. 
Louise Larsen to P. S. 1, 72, 83, 86, 89, Queens. 

Average number of case's for year by each visiting teacher 675 

Average number of calls at homes for year 1200 

Average number of miscellaneous calls fnr year 270 

Each visiting teacher has a schedule of definite times and days 
for calling at her several schools, arranged to suit her locality. 
Upon calling at a school she receives new cases from the principal 
or assistant to principal. A sample of the record card used is 
•reproduced here. 



Name of child - 
Residence._. 



Reported by _ 



VISITING TEACHER'S REPORT 

Bor..... P. S Grade Case No.. 

Date of Birth Place 



School Record 
When admitted..,. 

Effort 

Proficient in. 

Deficient in. 

Conduct 

Absence. „ 



Grades repeated.... 
Heauth Recoiu) 



Personal History. Out of School Activities 



Home Conditions 

..Father's Name _ Occupatic 

..Mother's Name.„ - Occupatic 

..Other Children..-.. .Ages 



172 



VISITING teacher's 
Special Difficdlties 


REPORT — Continued 

Agencies InteHested 






















" 


































Action Taken 
D»™ __ - - . 


Result 


' 












■ 












































, 





Vitilivg Teacher. 



She confers with the classroom teacher over the child's special 
difficulties for in order to present the matter effectively to the 
parent she must have a detailed record. Frequently she inter- 
views the child also in school. All important action taken is 
recorded on the card with the date of entry, and when not in use 
this card is filed in the school. 

After interviewing parents at home or in the shop, or in the 
evenings when necessary, the visiting teacher reports back to the 
principal and teacher whatever may help them in understanding 
the child. She may also think best to interest or consult social 
agencies in the matter. A case is followed up till an adjustment 
is made, but in the stress of work, revisiting has to be a matter 
of discretion. 

A monthly report, a sample of which is here reproduced, is sent 
in duplicate to Associate Superintendent Edson and to the Dis- 
trict Superintendent. An annual detailed report is also sub- 
mitted. 



173 

DEPARTMENT OF EDUCATION 

THE CITY OF NEW YORK 

MONTHLY REPORT OF VISITING TEACHER 

Borough District Schools Month 

I. Scope of Work. 

Number of cases held over from preceding month.... 

Number of new cases 

Number of cases closed 

Number of cases reopened 

Number of visits to homes 

Number of homes visited twice 

Number of homes visited more than twice 

Number of miscellaneous visits 

II. Classification of Causes. 

Irregular attendance 

Lateness 

Poor scholarship 

Home conditions 

Poverty 

Health 

Conduct 

III. Preventive and Helpful Agencies. 

Mothers' clubs .| ........ 

Charity organizations 

Hospitals 

Society for Prevention of Cruelty to Children 

Department of Health 

Children's Court 

Other organizations 

IV. Interesting Cases (two or more cases in some detail on attached 

sheets). 

V. Comments. 

(Signed) 

Visiting Teacher. 

Address 

Date 19 Borough 

(Signed) 



District Superintendent. 



This blank to be sent in duplicate, at the close of each month, to the 
District Superintendent, who will forward one copy to Associate Superin- 
tendent Edson. 



174 



SUMMARY OF ANNUAL REPORTS 



Cases referred to the visiting teachers may be explained under 
the following groups : 

Poor scholarship, which includes children who are deficient 
in lessons, repeating grades or in danger of doing so, or 
suspected of feeblemindedness. 

Conduct, which means not incidental misbehavior but that 
which is unusual or peculiar, or misconduct which might 
become habitual ; conduct out of school causing complaint 
or suspicion of morals. 

Home conditions, which require investigation for neglect, 
poverty, misfortune, morals, cruelty, improper guardian- 
ship, lack of co-operation with the school, etc. 

Attendance, especially those children asking for working 
papers, or children graduating who should be allowed to 
attend high school. 

Lateness and intermittent attendance due to home conditions 
which require special adjustments or advice with parents. 

Health, which means special physical defects, not nurses' cases, 
but children requiring special diagnosis at a clinic, or a 
class for the physically handicapped ; also neurotic, tem- 
peramental, and mentally peculiar children. 

As most of the cases this year have come under the first four 
headings, these will be taken up in some detail. 



MALADJUSTMENTS IN SCHOLARSHIP 

Children deficient in lessons or repeating grades are often so 
analyzed and adjusted that thereafter they make normal progress. 
Some children are deprived of time to study by working after 
school in the parent's shop, or illegally for a merchant, or are 
doing "beadwork, or finishing" at home till late hours. The visit- 
ing teacher shows the parent how to manage without the child's 
assistance, or if there is financial strain, she secures relief. She 
points out to the parent the harm he is doing the child, and her 



175 

suggestions are usually accepted, for the parent naturally wishes 
to do the best for his child. 

The child who fails may be deceiving his parents about his 
class standing, or he may state that he receives no report card or 
has no home work. Many parents do not understand the ratings 
and believe the false interpretation of the child. The visiting 
teacher when bringing the child's failure to the attention of the 
parent also shows him how to avoid such ignorance in the future, 
and how to keep in touch with the child's progress. 

Many studious children prepare their home work, but have 
such lax methods of study that they dawdle for hours over les- 
sons that should consume an hour. They may have poor habits 
of attention or concentration, or study in the midst of family 
chatter and confusion. The visiting teacher suggests better meth- 
ods of study, regular hours for work, and greater concentration, 
so that the child not only forms good habits, but has time for 
recreation, helping mother, and sufficient sleep. 

The visiting teacher finds many children who, through dis- 
couragement from their inability to keep up with the class, have 
formed the habit of failure. A special disability may have caused 
the child to lose interest. Personal influence, motivation, locating 
the cause of failure and pointing a remedy, obtaining a little ex- 
tra help at the critical time, are all means used by the visiting 
teacher. Older brothers and sisters, big Sisters, or the teacher, 
when she has a spare moment, will help the visiting teacher on 
such a problem. 

ILLUSTRATIONS 

Willis was an over age backward boy who never prepared lessons 
and was always in trouble. He told his teacher he had to work on a 
delivery wagon after school because his family was poor. The mother 
told the visiting teacher they were poor; but not satisfied that the 
economic pressure was so great, the visiting teacher called at an hour 
when the father was at home. He told her willingly how much he 
earned, and how anxious he was to have all his children graduate from 
school. Willis did not have to work, but had given his father the im- 
pression that he had no home study. We stopped his illegal employ- 
ment, and had him prepare home work. The school had a different 
attitude toward Willis, and his conduct and scholarship improved. 



176 

Pauline was not only deficient herself but was jeopardizing the dis- 
cipline and progress of the 8B class. She would exclaim, "I can't 
write," or "I can't do arithmetic," or "I can't sew, I just can't!" and 
she seemed firmly to believe in her own impotency. I called at her 
home to get light on this hysterical condition. The mother was almost 
blind, and Pauline was evidently overwrought by study and housework. 
I suggested simplified housekeeping and other changes that would 
tend to keep her from a breakdown. But from the mother I drew out 
the fact that the child had a presentiment she would not graduate, 
and dreamed and talked of failure in her sleep. Knowing that she had 
natural ability I reassured her by promising to talk over her difficulties 
with the teacher. The teacher showed her how to overcome her diffi- 
culties. The "can'ts" vanished, she began to improve, and graduated 
with her class with no recurrence of the hysteria. 

The visiting teacher takes advantage of mental tests in deciding 
what recommendations to make for the child who is not getting 
along. She takes into account besides the intelligence, the history, 
environment, age, and emotional tendencies of the child. Children 
are often recommended for the Manhattan Trade School, or vo- 
cational training, examination for ungraded class, or rapid ad- 
vancement. The following is an illustration : 

William, ten years old, was a special case given to me by the district 
superintendent in December. He had been one year, nine months in 
4A owing to one thing or another. He had broken some glass and 
was therefore a court case. He had just been expelled from school 
for furious outbursts of temper. I gave him a psychological test and 
found he had an intelligent quotient of 140. With this information I 
accompanied him to the Children's Court, and when the judge asked 
me for my recommendations, I suggested that he be tried out in a 5A. 
Therefore the judge sentenced him to harder intellectual work, and 
suggested he be tried out as I had recommended. 

William was then entered at a new school in 4B-5A rapid advance- 
ment Terman class in January and at the end of April it was very in- 
teresting to me to learn that he had been elected class president by his 
classmates in spite of his ragged elbows, and that at a Trabue writing 
test as well as in geography and arithmetic he excelled all other chil- 
dren in this selected bright group. His mother is so delighted with 
the change in her boy that in spite of her poverty she gladly puts up 
his lunch and gives him his daily carfare. He has consistently main- 
tained the high record for scholarship and deportment that he gained 
the first day the change was made. The visiting teacher in the new 
school took up the work where I left it. 



177 



CONDUCT AND PREVENTIOTST OF TRUANCY 

The bad conduct of many children is traceable to faulty home 
training or no consistent training. The visiting teacher, in show- 
ing the parent better methods, also helps to prevent the recurrence 
of trouble with the younger children. Faulty hygiene, congenital 
neurosis, association with a neurotic or high-tempered member 
of the family may afifect the child's disposition. Physical and 
psychological examinations throw light on obscure cases. 

The visiting teacher does preventive work with children who 
show a tendency to do wrong or associate with evil companions. 
The class teacher discovers such tendencies of the mother appeals 
to the school for help. The visiting teacher obtains a change of 
occupation or interest, suitable recreation, directed reading, but 
above all personal influence and careful follow-up work are 
needed. The time so spent is well repaid in child saving. She 
may ask Big Brothers and Sisters to assist. Extreme cases are 
referred to the S. P. C. C, whose help has been most effective in 
ridding the neighborhood of evil influences and bad characters. 



ILLUSTRATIONS 

Jacob, 13 years old, in 8A, was reported as "D" in conduct, can do 
his work but is making little effort." Mother had been sent for with- 
out success, and so the child was referred to the visiting teacher. 
When the mother heard the reason for the call, she exclaimed, "I know 
all about him! I can't help it. He's just a bad boy; send him away. 
I don't care." I encouraged her to tell me her troubles. She was not 
well ; business was not prosperous and she had helped her husband 
in the store as much as her health would allow, and the boy had been 
unintentionally neglected. He was getting no ethical training because 
he refused to remain at home and receive his lessons from the Rabbi. 
He had lost a book from the library which had to be paid for, con- 
sequently he was forbidden to read. Being naturally fond of reading 
he spent all the pennies he could save on "Nick Carter," as these books 
could be' procured second hand for a few cents. He was not allowed 
to join the Boy Scouts as "they could probably take him for a soldier." 
Altogether everything he liked seemed to be prohibited. After school 
he went to his father's shop to help. When everyone else was asleep 
he withdrew his books from their hiding place and read; consequently 
in school the next day he was not a promising pupil. 

12 



178 

The mother accepted most graciously the changes in treatment sug- 
gested by the visiting teacher. She promised to allow the boy to join 
the Boy Scouts, and to draw books from the library. The teacher 
gladly suggested a list of books that would help with his studies. He 
had "A" next month and was promoted that term. There was no fur- 
ther complaint. Frequently the mother insisted the advice was worth 
a hundred dollars to her, as she had been most discouraged and des- 
perate. 

In a congested part of the city, Lucy was losing her interest in les- 
sons and coming late to the afternoon session, offering as excuse that 
"mother was sick," but her classmates whispered to the teaclier that 
she was talking to boys on the .'■treet. The visiting teacher learned 
from the bed-ridden mother that Luc\' had changed since coming under 
the influence of a playmate, Elsie. Lucy's father was insane, and her 
brother an invalid, and from this dreary home-atmosphere Lucy es- 
caped at 3 P. M. to go no one knew whither till she came home at 
11 P. M. 

The visiting teacher saw the necessity of getting acquainted with 
Elsie, and went to her school. Elsie had an enviable record for re- 
peating grades, half days' absence, and poor conduct. The visiting 
teacher took this record to her home and questioned the parents. They 
were aware that Elsie had been left back and that sometimes she had 
been absent from home as well as from school ; but they had been 
unable to find out where she spent her time. 

The visiting teacher was not content with her explanation that she 
went "no place," and finally, by careful probing based on a study of 
the record card showing at what date she began to go wrong, got the 
information she was seeking. She sent for the Children's Society, and 
shortly they had under arrest the man who had lured Elsie and her 
friends to his rooms for no good purpose. He was convicted and 
sent to jail for "impairing the morals of youth." 

The visiting teacher kept these children under her care, looking 
out for their recreation and companionship as well as for their les- 
sons. Lucy became at once, when her friendship with Elsie was broken, 
a better student at school. Her mother lived to see her become again 
her faithful nurse and housekeeper. Elsie, because her habits of de- 
linquency were stronger, needed careful supervision at home and school. 
But the home co-operation was secured and she goes "no place" now 
that is not accounted for. Her interest in school is aroused so thai 
she is making progress. Her character is developing slowly, good 
points long dormant showing in her changed attitude. 



179 



HOME CONDITIONS 

The home presents many problems — from the well-meaning 
but inefficient mother, whose lack of system makes her "need 
Jennie to^ give her a hand" in the morning, and so Jennie is late ; 
or who says she "puts Johnnie on clean every day," but he 
comes with torn blouse and grimmy ears ; to the hard-working 
parent of ten children who has no time to differentiate the train- 
ing for one individualistic child, and wonders when she "gives 
him more licks than any of the others," he is still her one black 
sheep. Patiently the visiting teacher shows both mother and 
child the better way. Other parents leave the street to train 
the child. Poverty, step-parents, parents who disagree, one 
parent who is sick, or unfaithful, or mentally incompetent, are 
all problems which the visiting teacher meets. She gets in touch 
with relief societies, domestic relations courts, tuberculosis and 
mental hygiene clinics, clubs, social service departments of hospi- 
tals, convalescent homes, nurseries, etc., who co-operate with her 
in helping the family and the child. 

James' whole appearance showed neglect ; he came unkempt, un- 
washed, his clothes filthy and ragged. He was frequently absent or 
late. I found that the father had left home, but was contributing to 
the support of his family. I sought him out at his store, and told him 
that if, as he claimed, the mother was unfit to bring up his four chil- 
dren, then it was his duty to see to their moral and social training. 
James did better for a few days, then began to fall back, and I called 
again. Hearing more rumors about the mother I reported the case to 
the Children's Society, and meanwhile continued my work with the 
boy. He improved rapidly and will be promoted. The Children's 
Society report that the parents are now reconciled, and are giving 
adequate care to their children. 



CHILDREN KEPT IN SCHOOL 

Many children apply for working papers when there is no 
economic need. The child may be discouraged over failure in 
class, or lured by the high wage paid a friend. The parent may 
not see the ultimate advantage of education over present earning 
power. The visiting teacher is usually able to keep these children 
in school, and even when there is poverty, may secure a scholar- 
ship or enlist the help of relatives. 



180 

Some bright children graduate without signing for high 
school. Their parents frequently have the wrong impression of 
high school, or know nothing of the advantages open to those who 
have had secondary and college education. The visiting teacher's 
call brings a new vision. 

Grace had not reported for the 9A, and I found her at home helping 
her mother do embroidery to support the three younger children. The 
father was sick in the country. The mother consented to send her 
back to school when I explained the advantages of education, and the 
consequences of illegal employment. Grace attended regularly till she 
reached 9B. This time I found her doing crochet beading to pay the 
rent, for mother had been taken ill, and the father was now sick at 
home. Through a friend of the school $100 was contributed for the 
family. With the rent paid, and both parents under a physician's care, 
Grace finished her commercial course, happy in her fulfilled desire for 
an education. 

When the principal discovered a child with a perfect school record 
seeking working papers, and referred her to me that I might go and 
plead for a maximum of education, I rejoiced in the chance to seek 
out the child's father, even on a hot, dusty evening ; and I think that the 
man, awakened from sleep after a hard day's work, did not regret my 
call as we mapped out the girl's future. She is remaining in school. 



AMERICANIZATION 

Most of the visiting teachers work in neighborhoods largely 
foreign, where parents cling to their traditional customs and lan- 
guage, and believe their children should go to work at 12 or 14, 
the same as they did in the old world. Promptly at 3 P. M. a 
task is awaiting many of these little ones, or household drudgery 
begins, the parent considering that he has done his full share in 
giving up his child from 9 to 3. He looks upon education for his 
daughter as a waste for "she will marry'' and then he will have 
"no good of her." The visiting teacher has to convince him that 
his child is a bigger asset than the estimate put on her trivial 
earnings. 

The foreign parent complains of his "bad American children" 
for whom he blames "the country.'' The school child has far out- 
striped the father and mother in developing in this "free land." 
and the visitins: teacher must show the latter how to conserve 



181 

his parental authority. She encourages him to enter into the life 
of his child, to talk about the things that interest the child, his 
books, lessons, companions, game, and athletics; — on which the 
foreigner looks with suspicion. She shows him American ideals 
of democracy and leads him to live — not for his children but 
with his children. Thus she is not only helping the school to as- 
similate the child, but is aiding in the making of better Americans. 



SUGGESTIONS 

The visiting teacher is seriously handicapped by the lack of a 
room which she can call her own. Records should be kept where 
they may be consulted and properly filed, but the best the crowded 
school buildings afford are make-shift spaces which consume the 
time and energy of the visiting teacher. Children's affairs are 
of too intimate a nature to discuss in halls or assembly rooms. It 
is to be hoped that in the new buildings to be erected, some acces- 
sible room will be designed for the visiting teacher where she 
may file records, and interview children and social workers. 

The visiting teacher should be a neighborhood asset for a 
group of schools not too remote from one another for her to keep 
in touch with all. She cannot adequately attend to more than two 
or three schools — depending on the size. All visiting teachers 
agree that sporadic cases referred from many schools cannot be 
properly followed up, and are therefore an expenditure of visiting 
teacher's time with a disproportionate amount of gain and of 
discouragement to the worker. The attempt to adjust oneself 
to the demands of too many schools — with their varied systems 
and ideals — is an overwhelming demand on the nervous system 
of the visiting teacher. 

Travelling for five days a week through filthy tenements, fres- 
coed with vulgar expressions as far up as juvenile fingers can 
reach, conversing for many hours a day with difficult parents 
over elusive problems, often missing the noon rest to catch a 
parent at dinner time — all done for the sake of the children whose 
changed outlook on life makes every effort worth the while — 
this is the work of the visiting teacher. 



182 

She comes as a mutual help to school and home, and is needed 
in our congested districts as much by the good to keep them good 
as by the bad to reform them. The poor widow of an American 
citizen may need only to be told where to apply for a pension, or 
the invalid father of an exceptionally bright child shown the way 
to give his son a high school education. Therefore it is highly 
desirable that the visiting teacher be not associated wholly with 
"bad children" or used as a "scare." 

To the visiting teacher there is no "incorrigible child," yet 
she recognizes as perhaps no one else in the school work, the 
necessity for early recognition and referring of cases to her, to 
the end that she may conserve the child, and the time and energy 
of the teacher and the visiting teacher; and the partial elimina- 
tion at least of the "repeater" and the juvenile offender. With 
visiting teachers in all the schools all the deficient children could 
be analyzed and the difficult children adjusted, and none lost by 
transfer. 



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